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To explore brain function alterations in chronic insomnia (CI). 65 CI patients and 48 healthy controls were included to analyze abnormal alterations in brain spontaneous activity using static regional homogeneity (sReHo) and dynamic regional homogeneity (dReHo) methods. CI patients focused on decreased sReHo in bilateral lingual gyrus, bilateral middle occipital gyrus, bilateral inferior occipital gyrus and right superior occipital gyrus; decreased dReHo in bilateral superior occipital gyrus, bilateral cortical area around the talus fissure, and right middle occipital gyrus. CI patients exhibit abnormal activity in multiple brain regions, which can reflect the sleep quality index. [ABSTRACT FROM AUTHOR]

The present study aimed to explore the effectiveness of virtual reality (VR) therapy on sleep quality and associated symptoms, such as depression and anxiety, cognitive decline and autonomic nervous dysfunction, in chronic insomnia patients. Sixty-three chronic insomnia patients were randomly divided into VR group (n = 32) and control group (n = 20) based on a standard drug therapy. Patients were instructed to use VR at home once a day at evening for 6-week treatment. All participants received evaluations of subjective sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS), depression and anxiety symptoms measured with the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), cognitive function, and objective sleep structure and autonomic nerve function examination measured with the sleep respiration monitoring device at baseline and after 6-week treatment. The main objective of this study was sleep quality assessment as the primary outcome. After 6-week treatment, the decreases in PSQI score (−5.60 ± 2.37 vs −4.10 ± 1.80, P = 0.020) and ISI score (−8.81 ± 4.52 vs −6.35 ± 2.89, P = 0.038) of the VR group were significantly greater compared with the control group. The VR group showed more reduction in HAMD score (−9.96 ± 4.41 vs −7.50 ± 2.89, P = 0.035) and HAMA score (−8.96 ± 3.80 vs −6.80 ± 3.22, P = 0.046), and more increase in processing speed (0.54 ± 0.60 vs 0.00 ± 0.79, P = 0.011) than the control group. Moreover, the low-frequency coupling (−10.00 ± 17.40 vs. 8.25 ± 20.03, P = 0.001) was lowered and the high-frequency coupling (9.99 ± 17.40 vs. −8.24 ± 20.03, P = 0.001) was elevated in the VR group relative to the control group. Our findings offered preliminary evidence that VR therapy enhanced sleep quality and also lessened depressive and anxious symptoms, and improved cognitive and autonomic functioning in patients with chronic insomnia. • Virtual reality showed effect on sleep quality improvement. • Virtual reality alleviated depressive and anxious symptoms. • Virtual reality improved cognitive and autonomic functions. • Virtual reality is a promising therapy for patients with chronic insomnia. [ABSTRACT FROM AUTHOR]

Summary: Digital cognitive behavioural therapy for chronic insomnia (D‐CBT‐I) has been shown to be as efficacious as traditional CBT‐I. However, not all patients achieve insomnia remission after treatment. We explored the factors influencing the effectiveness of D‐CBT‐I in a clinical practice. A total of 414 Asian chronic insomniacs were studied during a 6 week D‐CBT‐I intervention. All patients were assessed at baseline and posttreatment and were determined to be remitters or non‐remitters, responders or non‐responders by posttreatment criteria; Insomnia Severity Index (ISI <8) or ISI reduction ≥8, to examine whether remission and response status were associated with patient baseline characteristics. The average baseline ISI score in all subjects was 16.29 points. At posttreatment, 192 (46.4%) patients achieved ISI remission and 218 (52.7%) patients demonstrated an ISI response. An increased baseline early morning awakening time and ISI score were independently associated with a lower odds for remission (OR, 0.995 and 0.991, respectively). Increased baseline Patients Health Questionnaire‐9 score was independently associated with higher odds for response (OR, 1.114). Our results suggest that D‐CBT‐I can be recommended as the first‐line treatment for chronic insomnia, particularly in insomniacs with milder insomnia symptoms and more severe depressive symptoms. Meanwhile, the effectiveness of D‐CBT‐I was adversely affected by longer early morning awakening time and higher insomnia severity at pretreatment, which may be improved by more intense intervention and greater therapeutic support or by traditional CBT‐I. [ABSTRACT FROM AUTHOR]

Background: Recently, significant scientific research breakthroughs have been witnessed in the treatment of chronic insomnia. However, it seems that there is currently no bibliometric analysis of this. Therefore, we hope to comprehensively review and analyze the scholarly system and research focus in the field of chronic insomnia treatment through bibliometric methods. Methods: Between 2000 and 2023, we explored various papers in relation to the treatment of chronic insomnia in the Web of Science Core Collection(WOSCC) database. Subsequently, the collected papers were subjected to bibliometric analysis utilizing CiteSpace, VOSviewer, and the "bibliometric" package in R language. Results: With China and the United States(USA) among them, a total of 2937 papers were published across 49 countries. Publications related to the treatment of chronic insomnia were increasing year by year. The Laval University, Washington University, Pittsburgh University, and Stanford University were key research institutions. The journal Sleep was widely popular in the field and was also one of the most cited journals. These papers came from 148 authors, with Morin, Charles M., Roth, Thomas, Espie, Colin A., Harvey, Allison G., and Buysse, Daniel J. publishing the most papers and Morin, cm being co-cited the most. The treatment process of chronic insomnia can be divided into three main stages: drug intervention, diseases related to chronic insomnia, and cognitive behavioral therapy and mental health. Keywords such as "children and adolescents", "novel coronavirus pneumonia" (COVID-19), "mental health" and "heart failure" have become the focus of current research. Conclusions: We carried out a detailed bibliometric review of the development trends and research results of chronic insomnia research through this study for the first time. The information it provides reveals recent research hotspots and cutting-edge issues, providing valuable reference materials for researchers focusing on the treatment of chronic insomnia. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia yet remains underutilised in general practice. Understanding patient motivations and barriers to engaging in psychological interventions for insomnia is critical. Theoretical frameworks, such as the theory of planned behaviour, are needed to identify variables related to intentions and behaviour change. Aim: To explore key influences that motivate individuals' intention to engage with psychological interventions for insomnia. Design and setting: Qualitative study consisting of an online survey and interviews with 20 community-dwelling participants with insomnia aged 26–75 years residing in Victoria, Australia. Method: Guided by the theory of planned behaviour, reflexive thematic analysis was used to identify factors influencing participants' intention to engage with psychological interventions for insomnia. Results: Participants reported positive attitudes towards psychological interventions for insomnia, stemming from negative beliefs about pharmacological sleep aids and the perceived benefits of a structured and evidence-based intervention. Important others positively influenced participants' intention to engage; however, the GP influence was less consistent and often indirect. Participants believed in the efficacy of psychological interventions, but several barriers hampered their ability to benefit from them. Accessibility was identified as a key facilitator, whereas lack of knowledge and clear referral pathways were the main barriers having an impact on uptake. Conclusion: This study highlights key factors influencing patients' intention to engage in psychological interventions for insomnia as well as opportunities for GPs to support uptake and engagement. Routine conversations about sleep health are essential to reduce the burden of untreated insomnia in the community, and the active promotion of evidence-based psychological interventions is needed. [ABSTRACT FROM AUTHOR]

Background: Chronic insomnia, affecting 15.9% of the population, is characterized by sustained hyperarousal and heightened somatic, cognitive, and cortical activity. Despite its prevalence, the precise impact of chronic insomnia on cognitive domains, particularly attention, working memory, and executive function, remains inadequately understood. Aim: This study aims to systematically investigate the cognitive functioning of adults with chronic insomnia. Methodology: A meticulously matched cohort of 80 participants, comprising 40 with chronic insomnia and 40 controls, participated in this cross-sectional study. The diagnosis followed strict criteria outlined in the International Classification of Sleep Disorders-3. Neuropsychological assessments, including the Digit Span Test, Stroop Test, and Trail Making Test, were employed to scrutinize attention, working memory, and executive function. Robust metrics, such as the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), supported the investigative approach. Results: Analysis revealed notable deficits in backward digit span, digit symbol substitution test, and Stroop Test (cards B and C) among chronic insomnia subjects compared to non-insomniac counterparts. Trail Making Test B indicated prolonged completion times in the chronic insomnia cohort. Despite comparable levels of anxiety and depressive symptoms, the chronic insomnia group exhibited higher ISI and PSQI scores, indicating the severity of their sleep disturbances. Conclusion: This cross-sectional analysis reveals cognitive deficits associated with chronic insomnia, specifically impacting attention, working memory, and executive function. Even with meticulous demographic controls, chronic insomnia leaves a discernible impact on cognitive functions. The study underscores the need for precise cognitive evaluations to reveal the latent impact of chronic insomnia, offering insights for targeted interventions.

Sleep disorders and psychiatric disorders stand in a bidirectional relationship. Sleep complaints are prominent in populations with psychiatric disorders, especially amongst people with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Consultations at sleep clinics offer opportunities to screen psychiatric disorders and to propose primary psychiatric care. This descriptive study was conducted on 755 patients making their first visit to sleep clinic, with 574 seeking consultation for suspected obstructive sleep apnoea-hypopnoea syndrome (OSAHS), 139 for complaints of insomnia, and 42 for complaints of hypersomnia. The results of 387 screening scales for MDD (BDI-II) and 403 for TSPT (PCL-5) were compared according to the reason given for the consultation. In the whole group, 12.1 % of patients presented a positive MDD screening and 4.9 % for PTSD. Among patients presenting with insomnia, 19.8 % had a positive screening for MDD, as compared to 9.3 % in patients presenting with suspected OSAHS (p = 0.02). Regarding PTSD, 9.7 % of patients seeking consultation because of insomnia had a positive screening, compared to 2.9 % among patients with suspected OSAHS (p = 0.03). Among patients with a positive screening for MDD, 40.5 % were not receiving antidepressant or mood stabilizer treatment. Positive screening for MDD and PTSD are frequent in patients who attend sleep centers, especially amongst those presenting with insomnia. Nearly half of the patients with positive screening for MDD or PTSD were not receiving a dedicated pharmacological treatment. These figures emphasize systematic screening for psychiatric disorders in sleep clinics. • The first visit to sleep clinic is a key gateway to primary psychiatric care. • Patients with insomnia complaints are at a high risk for MMD and PTSD positive screening. • Half of MDD positive screening patients lack pharmacological treatment. • Psychiatric screening in sleep centers is crucial, especially for insomnia complaints. [ABSTRACT FROM AUTHOR]

Objective: Diminished ovarian reserve (DOR) is a disorder characterized by impaired ovarian function. Sleep disorders are disruptions of the circadian rhythm, which appears to be closely linked to reproductive systems. This study aimed to investigate the impact of poor sleep quality on the ovarian reserve of childbearing-age women. Methods: A cross-sectional study was conducted in China from June 2021 to March 2023. In total, 102 participants diagnosed with chronic insomnia disorder were included in the study. Questionnaires were administered to assess participants' menstrual patterns, insomnia severity, anxiety, and depression. The anti-Müllerian hormone level and the basal antral follicle count were measured for ovarian reserve evaluation. Correlation analysis and ordinal logistic regression analysis were conducted. Results: The women with insomnia presented high percentages of hypomenorrhea, premenstrual syndrome, and dysmenorrhea (78.4%, 74.5%, and 46.1%, respectively). Severe sleep disorder in the past month was identified as an independent risk factor for hypomenorrhea and premenstrual syndrome (odds ratio [OR], 2.64 and OR, 2.688; p<0.05). The prevalence of DOR among women with insomnia (33.3%) was significantly higher than the average reported in previous studies for young women. Insomnia duration exceeding 1 year was determined to be an independent risk factor for DOR in women aged 36 to 40 years (OR, 4.5; p=0.033). Conclusion: This study highlights the association between sleep disorders and menstrual problems. Prolonged poor sleep quality in women aged 36 to 40 years was identified as a significant risk factor for DOR. We should pay more attention to improving sleep quality in order to maintain normal ovarian function. [ABSTRACT FROM AUTHOR]

Introduction: Delivering cognitive behavioral therapy for insomnia over the internet bears the advantage of accessibility and uptake to many patients suffering from chronic insomnia. In the current study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy for insomnia (iCBT-I) in routine care. Materials and methods: We conducted a two-arm non-blinded randomized controlled trial with care as usual (CAU) as a control condition. Participants were recruited in a specialized outpatient sleep medicine department. Both arms had access to other healthcare resources, and the intervention group had access to the iCBT-I program for 2 months. The primary outcome was insomnia severity, measured by the Insomnia Severity Index (ISI). Secondary outcomes were fatigue severity, daytime sleepiness, affective symptoms, dysfunctional beliefs and attitudes about sleep, sleep locus of control, sleep hygiene, sleep efficiency (SE), sleep onset latency, wake time after sleep onset (WASO), and total sleep time (TST). Linear mixed models for repeated measures were used to analyze the longitudinal data at baseline, post-treatment, and after 3 months of follow-up. The trial was registered at www.clinicaltrials.gov (NCT04300218 21.04.2020). Results: The results showed a significant time*group interaction effect (p = 0.001) at post-treatment with between-group effect size (d = 0.51), indicating that the ISI decreased by a score of 3.8-fold in the iCBT-I group than in the CAU group. There was no significant difference in ISI between groups at follow-up. Regarding secondary outcomes, dysfunctional beliefs about sleep, SE, and WASO decreased significantly during treatment in the intervention group with betweengroup effect sizes d = 0.35, d = -0.51, and d = 0.47, respectively. At the follow-up, between-group effects on DBAS and SE remained significant: d = 0.36 and d = -0.63, respectively. For TST, we observed a significant time*group effect of d = -0.38 only after follow-up. Conclusion: Our findings suggest that iCBT-I has a significant effect on insomnia severity at post-treatment compared to CAU. iCBT-I further improved dysfunctional beliefs about sleep and improved subjective sleep characteristics, such as SE, WASO, and TST during 3 months after treatment. [ABSTRACT FROM AUTHOR]

Previous studies have reported sex differences in altered brain function in patients with chronic insomnia (CI). However, sex-related alterations in brain morphology have rarely been investigated. This study aimed to investigate sex-specific grey matter (GM) alterations in patients with CI and to examine the relationship between GM alterations and neuropsychological assessments. Ninety-three (65 females and 28 males) patients and 78 healthy (50 females and 28 males) controls were recruited. Structural magnetic resonance imaging data were analysed using voxel-based morphometry to test for interactions between sex and diagnosis. Spearman's correlation was used to assess the associations among structure, disease duration, and sleep-, mood-, and cognition-related assessments. Males with CI showed reduced GM volume in the left inferior parietal lobe, left middle cingulate cortex, and right supramarginal gyrus. Females with CI showed increased GM volume in the right Rolandic operculum. Moreover, mood-related assessments were negatively correlated with GM volumes in the right supramarginal gyrus and left inferior parietal lobe in the male patients, and cognitive-related assessments were positively correlated with GM volumes in the Rolandic operculum in the female patients. Our findings indicate sex-specific alterations in brain morphology in CI, thereby broadening our understanding of sex differences in CI and potentially providing complementary evidence for the development of more effective therapies and individual treatments. [ABSTRACT FROM AUTHOR]

Background: In spite of the major role of early maladaptive schemas in vulnerability to various psychological disorders, studies about the relationship between early maladaptive schemas and insomnia disorder are scarce. Hence, the aim of the current study was to explore the contribution of early maladaptive schemas in insomnia severity by comparing a sample of patients with chronic insomnia and good sleepers. Methods: Patients with chronic insomnia and good sleepers were evaluated using Young Schema Questionnaire-Short Form (YSQ-SF), Depression Anxiety and Stress Scale (DASS-21), and Insomnia Severity Index (ISI). Results: The study enrolled 117 patients with chronic insomnia and 76 good sleepers. All early maladaptive schemas (EMSs) except for enmeshment showed significant correlations with insomnia severity. After controlling for depression/anxiety symptoms, logistic regression analysis showed that the EMSs including emotional deprivation, vulnerability to harm, and subjugation schemas were significantly associated with insomnia severity. Conclusions: These preliminary findings suggest that EMSs may constitute a vulnerability factor for developing insomnia. Early maladaptive schemas may require attention in the existing treatments of insomnia. [ABSTRACT FROM AUTHOR]

BackgroundHealthcare workers grapple with distinct challenges, inherent to their profession, making them susceptible to irregular sleep patterns and insufficient sleep, which may further impact their cardiovascular health. This study aimed to investigate the knowledge, attitude and practice (KAP) of healthcare workers concerning sleep hygiene and cardiovascular health.MethodsA cross-sectional survey was conducted at Yancheng TCM Hospital Affiliated with Nanjing University of Chinese Medicine between July, 2023 and September, 2023. Demographic characteristics, KAP scores, sleep health awareness and habits, and sleep quality were assessed through the questionnaires.ResultsA total of 423 valid questionnaires were included in the study. Among these, 215 (50.83%) were aged 35 or below, and 128 (30.26%) reported suffering from chronic insomnia. The mean knowledge, attitude, and practice scores were 43.23 ± 5.67 (possible range: 10–50), 24.53 ± 4.59 (possible range: 9–45), and 20.22 ± 4.46 (possible range: 6–30), respectively. Multivariate analyses indicated that attitude score (OR = 0.890, 95% CI: [0.807–0.981], p = 0.019), sleep health awareness & habits score (OR = 1.847, 95% CI: [1.284–2.656], p = 0.001), experienced chest tightness or heart palpitations (OR = 6.084, 95% CI: [2.172–17.042], p = 0.001), and the presence of chronic insomnia (OR = 5.017, 95% CI: [2.428–10.368], p

BackgroundInsomnia is a prevailing health problem among older adults. Tai Chi, a popular mind-body exercise practiced by older people in various oriental communities, has been shown to improve sleep. However, Tai Chi has not been directly compared to cognitive behavioral therapy for insomnia (CBT-I), which is the first-line non-pharmacological treatment for insomnia in older adults. This study aims to examine whether Tai Chi is non-inferior to CBT-I as a treatment for insomnia in older adults.MethodsThis is a single-center, assessor-blinded, non-inferiority randomized controlled trial comparing Tai Chi and CBT-I in 180 older adults aged ≥50 years with chronic insomnia according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Participants will be randomly assigned to either the Tai Chi or CBT-I group. Interventions will last for 3 months with a 12-month follow-up. The primary outcome is self-perceived insomnia severity measured by Insomnia Severity Index (ISI) at 3 months and at 15 months. The secondary outcomes include the remission rate of chronic insomnia, insomnia treatment response, subjective sleep quantity and quality, 7-day actigraphy, 7-day sleep diary, sleep medication, health-related quality of life, mental health, body balance and lower extremity function, adverse events, habitual physical activity, and dietary intake. Measurements will be conducted at baseline, 3 months, and 15 months by outcome assessors who are blinded to the group allocation.DiscussionThis will be the first non-inferiority randomized controlled trial to compare the efficacy and long-term outcomes of Tai Chi versus CBT-I for treating insomnia in older adults. This study will be of clinical importance as it supports the use of Tai Chi as an alternative non-pharmacological approach for insomnia treatment and sustainable management.

To investigate the short-term efficacy of enhanced external counterpulsation (EECP) on chronic insomnia. This is a pilot randomized, participant-blind, and sham-controlled study. Forty-six participants with chronic insomnia were randomly assigned in a 1:1 ratio to receive EECP or sham EECP intervention (total of 35 sessions with 45 min each). The primary outcome was Pittsburgh Sleep Quality Index (PSQI). The secondary outcomes included sleep diary, Hospital Anxiety and Depression Scale (HADS), Short-Form Health Survey (SF12), flow mediated dilation (FMD), serum biomarkers of melatonin, cortisol, interleukin-6, and high sensitivity C-reactive protein. Outcomes were assessed after treatment and at 3-month follow-up. The PSQI was significantly decreased in both EECP and sham groups after 35-session intervention (13.74 to 6.96 in EECP and 13.04 to 9.48 in sham), and EECP decreased PSQI more than sham EECP (p = 0.009). PSQI in two groups kept improved at 3-month follow-up. After treatment, the total sleep time, sleep efficiency, FMD value and SF12 mental component of EECP group were significantly improved, and group differences were found for these outcomes. At follow-up, total sleep time, sleep efficiency and SF12 mental component of EECP group remained improved, and group difference for SF12 mental component was found. Post-treatment and follow-up HADS-A significantly decreased in both groups, with no differences between groups. Post-treatment serum biomarkers showed no differences within and between groups. Lack of objective sleep measurement. EECP could improve sleep quality and mental quality of life in chronic insomnia and the therapeutic effect maintained for 3 months. • EECP could improve sleep quality and mental quality of life in chronic insomnia. • EECP significantly improved total sleep time, sleep efficiency, sleep initiation, sleep maintenance. • EECP significantly improved vascular endothelial function and psychological state. • The therapeutic effect of EECP on chronic insomnia maintained for 3 months. [ABSTRACT FROM AUTHOR]

to characterize possible differences in the function of the ANS in patients with chronic insomnia compared to a control group, using a wearable device, in order to determine whether those findings allow diagnosing this medical entity. Thirty-two patients with chronic insomnia and nineteen patients without any sleep disorder, as a control group, were recruited prospectively. Both groups of patients underwent an in-patient night with simultaneous polysomnography and wearable device recording Empatica E4 a diverse array of physiological signals, including electrodermal activity, temperature, accelerometry, and photoplethysmography, providing a comprehensive resource for in-depth sleep analysis. In polysomnography, patients suffering from insomnia showed a significant decrease in sleep efficiency and total sleep time, prolonged sleep latency, and increased wakefulness after sleep onset. Accelerometry results were statistically significant differences in the three axis (x, y, z) just in stage N3, no differences were observed between both groups in REM sleep. The lowest temperature was reached in REM sleep in both groups. Peripheral temperature did not decrease during the different sleep phases compared to wakefulness in insomnia, unlike in the control group. Heart rate was higher in patients with insomnia than in controls during wakefulness and sleep stage. Heart rate variability was lower in stage N3 and higher in REM sleep compared to wakefulness in both groups. Sweating was significantly higher in patients with insomnia compared to the control group, as indicated by Skin Conductance Variability values and Sudomotor Nerve. Our study suggests that patients with insomnia have increased sympathetic activity during sleep, showing a higher heart rate. Temperature and sweating significantly influence the different sleep phases. • The association between insomnia and cardiovascular events has raised a growing interest in sleep disorders in recent decades. • Accelerometry allowed identifying superficial sleep, SWS and REM sleep in both groups. Wearable devices have been considered a useful tool in the clinical practice of sleep medicine centers. • Patients with insomnia have increased sympathetic activity during sleep as they showed higher heart rate and heart rate variability during all stages of sleep. The association between chronic insomnia and hyper-activation may have consequences, increasing the risk of developing cardiovascular diseases. • Skin temperature variations related to the NREM and REM sleep cycles were minimal in the insomnia and control groups. Both groups showed the lowest temperature during REM sleep. • Sweating, were significantly influenced by the different sleep phases. [ABSTRACT FROM AUTHOR]

Chronic insomnia impairs the glymphatic system and may lead to cognitive impairment and dementia in elderly population. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) has been proposed as a non-invasive method to measure the activity of human brain glymphatic. We aim to explore whether glymphatic function is impaired in middle-aged and elderly chronic insomnia individuals and to identify the relationships between glymphatic dysfunction and cognitive impairment. A total of 33 chronic insomnia patients (57.36 ± 5.44 years, 30 females) and 20 age- and sex-matched healthy controls (57.95 ± 5.78 years, 16 females) were prospectively enrolled between May 2022 and January 2023. All participants completed MRI screening, cognition and sleep assessments, and DTI-ALPS index analysis. Our findings revealed that the DTI-ALPS index was significantly difference among the chronic insomnia patients with impaired cognition group (1.32 ± 0.14), with normal cognition group (1.46 ± 0.09), and healthy controls (1.61 ± 0.16) (p = 0.0012, p < 0.0001, p = 0.0008, respectively). Mini-Mental State Examination (MMSE) scores of chronic insomnia patients with cognitive impairment were positively correlated with the DTI-ALPS index (Partial correlation analyses after correction for age, sex, education level and duration of chronic insomnia: r = 0.78, p = 0.002). DTI-ALPS had moderate accuracy in distinguishing chronic insomnia patients with cognitive impairment from those with normal cognition. The glymphatic system dysfunction is involved in chronic insomnia among middle-aged and elderly individuals, and it has been found to be correlated with cognitive decline. • Middle-aged and elderly chronic insomnia patients have glymphatic system dysfunction. • Glymphatic system dysfunction is correlated with cognitive decline. • Glymphatic dysfunction can be detected even in the early stage of disease. [ABSTRACT FROM AUTHOR]

Insomnia, impacting 6-10% of the global population, is a multifaceted challenge to health and productivity. Chronic insomnia, linked to various health issues, demands comprehensive management. Traditional pharmacotherapies, effective yet raising dependency concerns, contrast with the nonpharmacological alternative, Cognitive Behavioral Therapy for Insomnia (CBT-I), addressing root causes. This paper explores diagnostic criteria, etiological factors, and patient education in insomnia management, incorporating keywords like behavioral therapy, chronic insomnia, and general sleep disturbances. Discussion emphasizes the evolving landscape, where behavioral interventions, notably CBT-I, demonstrate lasting efficacy, urging a shift towards personalized and comprehensive solutions. Societal consequences, including reduced productivity, underscore the imperative for effective, diversified approaches beyond traditional medications. The intricate challenges of insomnia necessitate a nuanced, individualized approach, with behavioral therapies as pivotal components, aligning with keywords such as non-pharmacological therapy and pharmacological. [ABSTRACT FROM AUTHOR]

Objective: To explore the therapeutic effect of GubenJiannao Anshen prescription combined with acupuncture on chronic insomnia and its influence on daytime brain function. Methods: A total of 120 patients with chronic insomnia admitted to our hospital from January 2021 to December 2022 were selected for the study. The patients were divided into groups according to the admission date, and 60 patients admitted on odd date were used as the matched group (receiving acupuncture treatment). Another 60 patients admitted on even dates were used as observation group (receiving GubenJiannao Anshen prescription combined with acupuncture treatment). The apparent rate, total response rate, Pittsburgh sleep quality index (PSQI) score, daytime insomnia symptom scale (daytime insomnia symptom scale) score were compared between the two groups. DISS), hyperarousal scale (HAS), incidence of adverse reactions, and short form 36 questionnaire (SF-36). Results: (1) The apparent rate was 71.67% in the observation group and 53.33% in the matched group, which was higher than that in the matched group(P<0.05). The total effective rate was 95.00% in the observation group and 83.33% in the matched group, which was higher than that in the matched group (P<0.05). (2) Pretherapy, sleep time, sleeping time, sleep quality, sleep efficiency, daytime dysfunction, sleep disorders, sleep medication scores and total scores of the two groups were compared (P>0.05); Post-treatment, the above scores of the two groups were decreased to different degrees, and the observation group was lower than the matched group(P<0.05). (3) pretherapy, DISS scores and HAS scores of the two groups were compared (P>0.05); Post-treatment, the above scores of the two groups were decreased to different degrees, and the observation group was lower than the matched group (P<0.05). (4) Post-treatment, the probability of adverse reactions such as nausea, vomiting, headache, dizziness, bitter mouth, fatigue and weakness, abnormal liver and kidney function was 6.67% in the observation group and 3.33% in the matched group, compared between the two groups (P>0.05). (5) pretherapy, the quality of life scores of the two groups were compared (P>0.05); Post-treatment, the quality of life scores of both groups were increased to different degrees, and the observation group was higher than the matched group (P<0.05). Conclusion: GubenJiannao Anshen prescription combined with acupuncture and moxibustion in the treatment of chronic insomnia can significantly improve the discernibility and total effective rate, improve the sleep disorder, improve the daytime brain function, and improve the excessive awakening state, and promote the quality of life of patients with high safety. [ABSTRACT FROM AUTHOR]

IntroductionDelivering cognitive behavioral therapy for insomnia over the internet bears the advantage of accessibility and uptake to many patients suffering from chronic insomnia. In the current study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy for insomnia (iCBT-I) in routine care.Materials and methodsWe conducted a two-arm non-blinded randomized controlled trial with care as usual (CAU) as a control condition. Participants were recruited in a specialized outpatient sleep medicine department. Both arms had access to other healthcare resources, and the intervention group had access to the iCBT-I program for 2 months. The primary outcome was insomnia severity, measured by the Insomnia Severity Index (ISI). Secondary outcomes were fatigue severity, daytime sleepiness, affective symptoms, dysfunctional beliefs and attitudes about sleep, sleep locus of control, sleep hygiene, sleep efficiency (SE), sleep onset latency, wake time after sleep onset (WASO), and total sleep time (TST). Linear mixed models for repeated measures were used to analyze the longitudinal data at baseline, post-treatment, and after 3 months of follow-up. The trial was registered at www.clinicaltrials.gov (NCT04300218 21.04.2020).ResultsThe results showed a significant time*group interaction effect (p = 0.001) at post-treatment with between-group effect size (d = 0.51), indicating that the ISI decreased by a score of 3.8-fold in the iCBT-I group than in the CAU group. There was no significant difference in ISI between groups at follow-up. Regarding secondary outcomes, dysfunctional beliefs about sleep, SE, and WASO decreased significantly during treatment in the intervention group with between-group effect sizes d = 0.35, d = −0.51, and d = 0.47, respectively. At the follow-up, between-group effects on DBAS and SE remained significant: d = 0.36 and d = −0.63, respectively. For TST, we observed a significant time*group effect of d = −0.38 only after follow-up.ConclusionOur findings suggest that iCBT-I has a significant effect on insomnia severity at post-treatment compared to CAU. iCBT-I further improved dysfunctional beliefs about sleep and improved subjective sleep characteristics, such as SE, WASO, and TST during 3 months after treatment.Clinical trial registrationwww.clinicaltrials.gov, identifier (NCT04300218).

Abstract Background Insomnia is a prevalent sleep disorder that affects up to 15% of the population worldwide and is the second most common mental health issue. There is increasing interest in the effects of long-term insomnia on cognitive function. Electroacupuncture can effectively improve cognitive function and sleep quality, yet the underlying brain network mechanisms remain unclear. This study aims to explore the network regulatory mechanisms associated with enhanced cognitive function and sleep quality, providing theoretical support for the use of electroacupuncture in the clinical treatment of chronic insomnia. Methods This study is divided into two parts. Sixteen individuals with chronic insomnia and 16 healthy controls of similar age and gender will be recruited in Study 1 to examine the brain network topology of individuals with chronic insomnia. Study 2 will be a randomized controlled trial with 120 chronic insomnia patients divided into three groups: Group A (electroacupuncture plus placebo drug), Group B (drug plus placebo electroacupuncture), and Group C (placebo electroacupuncture plus placebo drug). Participants will be exposed to 24 treatments over an 8-week period (3 times per week) and monitored for 12 additional weeks. The primary outcome measure will be changes in brainwave data from before to after the treatment. In addition, the Wisconsin Card Sorting Test and the Pittsburgh Sleep Quality Index will be utilized as secondary outcomes to measure from before to after treatment and during the follow-up. A correlation analysis will be conducted to explore links among modifications in brainwave patterns, Wisconsin Card Sorting Test scores, and Pittsburgh Sleep Quality Index scores. Additionally, any adverse events will be strictly monitored. Discussion Electroacupuncture may represent an alternative treatment for chronic insomnia, and this trial is expected to reveal the brain mechanism by which electroacupuncture improves cognitive function and sleep quality in chronic insomnia patients. Trial registration ChiCTR2200060150 (Chinese Clinical Trial Registry, http://www.chictr.org.cn , registered on 20 May 2022).

Although melatonin (MLT) is the molecule most used by pediatricians for sleep problems, scarce evidence exists on its use in healthy pediatric population. The objective of this study was to describe MLT use by Italian pediatricians in healthy children with chronic insomnia. A cross-sectional open survey was administered to Italian pediatricians, between June and November 2022, collecting information about their use of MLT in healthy children: age range of patients, dosages used, time of administration, duration of treatment, association with other treatments, perceived efficacy, and side effects. Data were reported as frequencies with their respective 95% confidence intervals. Chi-square statistics assessed significant differences between pediatricians who had training in pediatric sleep and those who did not. Among 428 respondents, 97.4% of pediatricians used MLT; 87.3% of them prescribed MLT in children aged 1–2 years, 62.1% in 2–5 years and 42.5% in 10–18 years. 84.9% of them suggested to take MLT 30 min before bedtime. 37.9% indicated to continue treatment for one month, 30.2% for 2–3 months. 74.1% of pediatricians usually prescribed MLT 1 mg/day. The most frequent treatment associated with MLT was sleep hygiene (85.4%). Almost all pediatricians found MLT effective in reducing difficulties falling asleep. Only 3.2% of them reported mild side effects. MLT is widely prescribed by Italian pediatricians, but no consensus exists about its use in typically developing children. There is a need for clear guidelines to optimize the use of MLT in healthy children. • Melatonin is commonly prescribed by pediatricians. • No consensus exists on melatonin use in healthy pediatric population with chronic insomnia. • The majority of pediatricians usually prescribe melatonin 1 mg/day. • The main effect was related to an improvement of sleep latency. • There is a need for clear guidelines to optimize the use of MLT in healthy children. [ABSTRACT FROM AUTHOR]

Background: Insomnia is a prevalent sleep disorder that affects up to 15% of the population worldwide and is the second most common mental health issue. There is increasing interest in the effects of long-term insomnia on cognitive function. Electroacupuncture can effectively improve cognitive function and sleep quality, yet the underlying brain network mechanisms remain unclear. This study aims to explore the network regulatory mechanisms associated with enhanced cognitive function and sleep quality, providing theoretical support for the use of electroacupuncture in the clinical treatment of chronic insomnia. Methods: This study is divided into two parts. Sixteen individuals with chronic insomnia and 16 healthy controls of similar age and gender will be recruited in Study 1 to examine the brain network topology of individuals with chronic insomnia. Study 2 will be a randomized controlled trial with 120 chronic insomnia patients divided into three groups: Group A (electroacupuncture plus placebo drug), Group B (drug plus placebo electroacupuncture), and Group C (placebo electroacupuncture plus placebo drug). Participants will be exposed to 24 treatments over an 8-week period (3 times per week) and monitored for 12 additional weeks. The primary outcome measure will be changes in brainwave data from before to after the treatment. In addition, the Wisconsin Card Sorting Test and the Pittsburgh Sleep Quality Index will be utilized as secondary outcomes to measure from before to after treatment and during the follow-up. A correlation analysis will be conducted to explore links among modifications in brainwave patterns, Wisconsin Card Sorting Test scores, and Pittsburgh Sleep Quality Index scores. Additionally, any adverse events will be strictly monitored. Discussion: Electroacupuncture may represent an alternative treatment for chronic insomnia, and this trial is expected to reveal the brain mechanism by which electroacupuncture improves cognitive function and sleep quality in chronic insomnia patients. Trial registration: ChiCTR2200060150 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 20 May 2022). [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical application value of transcranial direct current stimulation (tDCS) combined with eszopiclone in treating chronic insomnia. Methods Sixty-eight patients with chronic insomnia were randomized into the control group (n=35, false tDCS combined with eszopiclone) and the study group (n=33, tDCS combined with eszopiclone). Both groups were treated for 4 weeks. Clinical efficacy after treatment, polysomnography (PSG) results, serum cortisol (CORT) and adrenocorticotropic hormone (ACTH) levels, Pittsburgh Sleep Quality Index (PSQI) scores, Patient Health Questionnaire-9 (PHQ-9) scores, the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) scores and adverse reaction were compared between the two groups. Results After 4 weeks of treatment, the total effective rate was higher in the study group (93.94%, 31/33) than that in the control group (74.29%, 26/35, P＜0.05). After 2 weeks and 4 weeks of treatment, compared with the control group, the total sleep time (TST) was longer, sleep latency (SL) was shorter, the proportion of stage N3 sleep and sleep efficiency (SE) were higher, microarousal index, the proportion of stage N1 sleep, serum CORT and ACTH levels were lower in the study group (P＜0.05). After 4 weeks and 6 months of treatment, PSQI scores and PHQ-9 scores were lower in the study group than those of the control group (P＜0.05). After 2 weeks, 4 weeks and 6 months of treatment, GAD-7 scores were lower in the study group than those of the control group (P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment (P＞0.05). Conclusion tDCS combined with eszopiclone can improve sleep quality in patients with chronic insomnia, reduce anxiety and depression and have long-term effect. The mechanism may be related to the down regulation of serum CORT and ACTH levels in patients. [ABSTRACT FROM AUTHOR]

Introduction Chronic insomnia affects 5% to 10% of the US population, increasing the demand for treatment options and the corresponding research to prove their validity.1 This review compares recommendations from 3 clinical guidelines and summarizes hypnotic medications, including their newly reported side effects not mentioned in the guidelines. In addition, we aim to provide an overview of what pharmacotherapies are available for prescribers and patients. Methods A literature search was conducted for articles published prior to January 10, 2022, and case reports and clinical studies were retrieved from PubMed and Google Scholar. Results Definitive conclusions cannot be drawn regarding the safety and efficacy of medications reviewed; however, trends are apparent. All 3 guidelines included in this review remarked most treatment recommendations as weak except for cognitive behavioral therapy for insomnia, which is effective but not readily available. Furthermore, based on the 15 case reports and 13 clinical studies presented in this review, many of the medications used for treatment of insomnia present safety concerns. Discussion Benzodiazepines and benzodiazepine receptor agonists are commonly used hypnotic agents with the “Z-drugs” having robust data establishing their efficacy for the short-term treatment of chronic insomnia. However, significant adverse effects related to the central nervous system (CNS), including developing tolerance, addiction, CNS depression, and amnesia, remain barriers to their long-term use. In comparison, newer agents present more favorable side-effect profiles although with less established efficacy. Additionally, off-label agents, including antidepressants, antihistamines, and natural supplements, are discussed due to their prominent use.

Abstract Background Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive behavioral treatment for insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Academy of Sleep Medicine, and the American College of Physicians. CBTI is highly effective but has limited scalability. It is often unavailable in clinical settings where service members receive sleep care. Digital technologies offer unique opportunities to scale and broaden the geographic reach of CBTI services and support increased patient access and engagement in behavioral sleep care. This study aims to evaluate the impact and acceptability of digital CBTI hubs to augment military treatment facilities’ capabilities in behavioral sleep medicine. Methods This is a multi-site, non-inferiority randomized clinical trial designed to compare the effects of in-person (face-to-face or virtual) insomnia care as usual at three military sleep clinics versus CBTI delivered remotely and asynchronously through digital CBTI hubs. Digital CBTI hubs are led by licensed, certified clinicians who use NOCTEM’s® evidence-based clinical decision support platform COAST™ (Clinician Operated Assistive Sleep Technology). Changes in insomnia severity and daytime symptoms of depression and anxiety will be compared at baseline, at 6–8 weeks, and at 3-month follow-up. Patient satisfaction with insomnia care as usual versus digital CBTI hubs will also be examined. We hypothesize that digital CBTI hubs will be non-inferior to insomnia care as usual for improvements in insomnia and daytime symptoms as well as patient satisfaction with insomnia care. Discussion Digital technology has a high potential to scale CBTI accessibility and delivery options required to meet the insomnia care needs of military service members. Digital CBTI hubs using COAST offer a novel approach to broaden service members’ access to CBTI and to serve as an augmentation strategy for existing sleep services at military treatment facilities. The pragmatic approach leveraging technology in this trial has the potential to rapidly inform clinical practice within the Defense Health Agency as well as other healthcare systems. Trial registration ClinicalTrials.gov NCT05490550. Registered on 14 July 2023.

Purpose of reviewResponse to cognitive-behavioral therapy for insomnia (CBT-I) is variable across individuals, and specialty insomnia clinics that provide CBT-I are few. To personalize insomnia treatments and maximize the cost-effectiveness of CBT-I, this paper reviews the conceptual model and content of CBT-I and the predictors of adherence/response to CBT-I as the basis for understanding who is most likely to benefit from CBT-I.Recent findingsSpecific patient-related attributes that predict benefit from CBT-I include (1) presence of maladaptive behaviors that serve as perpetuating factors of insomnia; (2) greater motivation to pursue therapy and higher treatment expectancies regarding CBT-I; (3) reduced use of hypnotics; (4) longer sleep duration; and (5) adequately treated psychiatric comorbidities.SummaryPeople presenting with chronic insomnia and these attributes may warrant prioritization in referral to behavioral insomnia clinics. Conversely, those who do not have such favorable characteristics may require interventions that address modifiable factors associated with poor adherence/response to CBT-I.

Wan Y, Lv M, Zhou K, et al. Nat Sci Sleep. 2023;15:511-522. The authors wish to advise that an unauthorized version of the Chinese MMSE was used by the study team without permission. The MMSE is a copyrighted instrument and may not be used or reproduced in whole or in part, in any form or language, or by any means without written permission of PAR (www.parinc.com). The issue was resolved between the authors and PAR. The authors confirm that no test items from the unauthorized version of the Chinese MMSE are included in the article.

Yahui Wan,1 Mengdi Lv,2 Kaili Zhou,1 Zheng Li,3 Xueyun Du,1 Wei Wu,4 Rong Xue4 1Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China; 2Departments of Neurology, Tianjin First Central Hospital, Tianjin, 300190, People’s Republic of China; 3Departments of Neurology, Binhai Hospital, Peking University, Tianjin, 300450, People’s Republic of China; 4Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of ChinaCorrespondence: Rong Xue, Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China, Email xuerong1403@126.comPurpose: To evaluate the correlation between sleep microstructure, autonomic nervous system activity, and neuropsychological characteristics in chronic insomnia (CI) patients with obstructive sleep apnea (OSA).Patients and Methods: Forty-five CI-OSA patients, forty-six CI patients and twenty-two matched healthy control subjects (HCs) were enrolled. CI-OSA patients were then divided into two groups: mild OSA and moderate-to-severe OSA. All participants completed neuropsychological tests, which included the Hamilton Depression and Anxiety Scales (HAMD and HAMA), the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Mini-mental State Examination (MMSE). The autonomic nervous system activity and sleep microstructure were examined by the PSM-100A.Results: The CI-OSA patients exhibited higher scores on the PSQI, ESS, ISI, HAMA, and HAMD than HCs and CI patients (all p < 0.01). The CI-OSA patients had a lower proportion of stable sleep, REM sleep and a higher proportion of unstable sleep ratio (all p < 0.01) than HCs and CI patients (all p < 0.01). The CI-OSA patients had higher ratios of LF and LF/HF, and lower ratios of HF and Pnn50% (all p < 0.01) than HCs and CI patients (all p < 0.01). Compared to CI-mild OSA patients, the CI-moderate-to-severe OSA patients presented with a higher ESS scores, higher ratios of LF and LF/HF, and lower ratios of HF (all p < 0.05). In CI-OSA patients, higher HAMD scores were correlated with decreased MMSE scores (r=− 0.678, p < 0.01). A higher LF ratio was correlated with higher HAMD and HAMA scores (r=0.321, p=0.031, r =0.449, p =0.002), and a higher HF ratio was correlated with lower HAMD and HAMA scores (r=− 0.321, P =0.031, r =− 0.449, p =0.002).Conclusion: OSA exacerbates the abnormalities of sleep microstructure and the autonomic nervous dysfunction in CI patients. Dysfunction of the autonomic nervous system could contribute to mood deterioration in CI with OSA patients.Keywords: chronic insomnia, obstructive sleep apnea, OSA, depression, sleep microstructure, autonomic function

Social restriction measures (SRM) implemented during the COVID-19 pandemic led to a reduction in time spent outdoors (TSO). The aim of this study was to describe TSO and evaluate its association with sleep outcomes, optimism, happiness and health-status before and during SRM. Two online surveys were conducted in 2017 (N = 1004) and 2020, during SRM (N = 1010), in samples representative of the age, sex and region of the Austrian population. Information on the duration of TSO, sleep, optimism, happiness and health-status was collected. Multivariable-adjusted logistic regression models were used to study the association of TSO with chronic insomnia, short sleep, late chronotype, optimism, happiness and self-rated health-status. The mean TSO was 3.6 h (SD: 2.18) in 2017 and 2.6 h (SD: 1.87) during times of SRM. Men and participants who were older, married or in a partnership and lived in a rural area reported longer TSO. Participants who spent less time outdoors were more likely to report short sleep or a late chronotype in both surveys and, in 2020, also chronic insomnia. Less TSO was associated with lower happiness and optimism levels and poor health-status. Our findings suggest that TSO may be a protective factor for sleep, mood and health, particularly during stressful and uncertain times.

Abstract Background The treatment of insomnia, which is the most common sleep disorder, includes drug and behavioral treatment, but each treatment measure has its limitations. So new treatment method needs to be taken to improve the treatment effect. MN supplementation is a potential promising new method for the treatment of insomnia, resulting in a rising need for methodological research towards verifying its efficacy. Methods/design We describe a proposal for a multicenter, patient-assessor-blinded, randomized controlled trial with two parallel arms. A total of 400 chronic insomnia patients will be allocated 1:1 to the intervention group (treatment with oral NMN 320 mg/day) or control group (treatment with oral placebo). All subjects are clinical chronic insomnia patients who meet all inclusion criteria. All subjects are treated by taking NMN or placebo. The primary outcome is the score on the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes are the score on the Insomnia Severity Index (ISI) and Epworth Sleeping Scale (ESS), the total sleep time (TST), sleep efficiency (SE), sleep latency, and REM sleep latency to assess sleep quality changes. Subjects are assessed at two time points: baseline and follow-up. The duration of the clinical trial is 60 days. Discussion This study will provide more evidence on the effects of NMN on improving sleep quality among patients with chronic insomnia. If proven effective, NMN supplement can be used as a new treatment for chronic insomnia in the future. Trial registration Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR2200058001. Registered on 26 March 2022.

Objective: The objective was to assess the association between self-reported infections and sleep duration, sleep debt, chronic insomnia, and insomnia severity. Methods: In total, 1023 participants were recruited from the Norwegian practice-based research network in general practice to a cross-sectional online survey with validated questions about sleep habits and insomnia symptoms (Bergen Insomnia Scale (BIS) and Insomnia Severity Index (ISI)), and whether they had experienced various infections during the last three months. Data were analyzed with chi-square tests and logistic regressions with adjustment for relevant confounders. Results: Self-reported short sleep duration (9 h) was associated with increased odds of throat (OR = 3.33) and ear infections (OR = 5.82), compared to sleep duration of 6–9 h, respectively. Sleep debt of >2 h was associated with increased odds of the common cold (OR = 1.67), throat infection (OR = 2.58), ear infection (OR = 2.84), sinusitis (OR = 2.15), pneumonia/bronchitis (OR = 3.97), influenzalike illness (OR = 2.66), skin infection (OR = 2.15), and gastrointestinal infection (OR = 2.80), compared to no sleep debt. Insomnia (based on BIS and ISI) was associated with throat infection (OR = 2.06, 2.55), ear infection (OR = 2.43, 2.45), sinusitis (OR = 1.82, 1.80), pneumonia/bronchitis (OR = 2.23, 3.59), influenzalike illness (OR = 1.77, 1.90), skin infection (OR = 1.64, 2.06), gastrointestinal infection (OR = 1.94, 3.23), and eye infection (OR = 1.99, 2.95). Conclusions: These novel findings support the notion that people who have insufficient sleep or sleep problems are at increased risk of infections.

ObjectiveTo assess the efficacy and safety of fecal microbiota transplantation (FMT) for adult chronic insomnia.MethodsPatients treated with FMT for chronic diseases were divided into chronic insomnia and non-insomnia group. The primary endpoint was the efficacy of FMT for insomnia 4 weeks after treatment, the secondary endpoints included the impacts of FMT on anxiety, depression, health-related quality of life, gut microbiota, and adverse events associated with FMT. Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) were utilized to assess the efficacy of FMT on insomnia, self-rating anxiety/depression scale [Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS)] was employed to evaluate anxiety and depression. Quality of life was evaluated by SF-36. 16S rRNA sequencing was employed to analyze the gut microbiota and correlation analysis was performed.ResultsForty patients met the inclusion criteria and seven were excluded. 33 patients were enrolled and stratified into chronic insomnia group (N = 17) and non-insomnia group (N = 16). Compared to baseline, FMT significantly ameliorated the ISI (17.31 ± 5.12 vs. 5.38 ± 5.99), PSQI (14.56 ± 2.13 vs. 6.63 ± 4.67), SAS (54.25 ± 8.90 vs. 43.68 ± 10.64) and SDS (57.43 ± 10.96 vs. 50.68 ± 15.27) score and quality of life of chronic insomnia patients. 76.47% (13/17) of insomnia patients achieved the primary endpoints. In chronic insomnia patients, the relative abundance of Eggerthella marked enhanced at baseline, while the relative abundance of Lactobacillus, Bifidobacterium, Turicibacter, Anaerostipes, and Eisenbergiella significantly increased after FMT treatment, the latter positive correlated with the efficacy of FMT. Encouragingly, FMT also improved the sleep quality of non-insomnia patients.ConclusionEggerthella may potentially serve as a distinctive genus associated with chronic insomnia. FMT maybe a novel treatment option for adults with chronic insomnia and provide an alternative to traditional treatments for insomnia. The effects were positive correlated with the augmentation of probiotics, such as Bifidobacterium, Lactobacillus, Turicibacter, and Fusobacterium.

Background: Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive behavioral treatment for insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Academy of Sleep Medicine, and the American College of Physicians. CBTI is highly effective but has limited scalability. It is often unavailable in clinical settings where service members receive sleep care. Digital technologies offer unique opportunities to scale and broaden the geographic reach of CBTI services and support increased patient access and engagement in behavioral sleep care. This study aims to evaluate the impact and acceptability of digital CBTI hubs to augment military treatment facilities' capabilities in behavioral sleep medicine. Methods: This is a multi-site, non-inferiority randomized clinical trial designed to compare the effects of in-person (face-to-face or virtual) insomnia care as usual at three military sleep clinics versus CBTI delivered remotely and asynchronously through digital CBTI hubs. Digital CBTI hubs are led by licensed, certified clinicians who use NOCTEM's® evidence-based clinical decision support platform COAST™ (Clinician Operated Assistive Sleep Technology). Changes in insomnia severity and daytime symptoms of depression and anxiety will be compared at baseline, at 6–8 weeks, and at 3-month follow-up. Patient satisfaction with insomnia care as usual versus digital CBTI hubs will also be examined. We hypothesize that digital CBTI hubs will be non-inferior to insomnia care as usual for improvements in insomnia and daytime symptoms as well as patient satisfaction with insomnia care. Discussion: Digital technology has a high potential to scale CBTI accessibility and delivery options required to meet the insomnia care needs of military service members. Digital CBTI hubs using COAST offer a novel approach to broaden service members' access to CBTI and to serve as an augmentation strategy for existing sleep services at military treatment facilities. The pragmatic approach leveraging technology in this trial has the potential to rapidly inform clinical practice within the Defense Health Agency as well as other healthcare systems. Trial registration: ClinicalTrials.gov NCT05490550. Registered on 14 July 2023. [ABSTRACT FROM AUTHOR]

Aim: Sleep is an essential part of a healthy life. Many people experience insomnia due to their living conditions. Matrix metalloproteinases (MMPs) play an essential role in remodeling the microenvironment. Tissue inhibitors of MMPs (TIMPs) maintain a balance with MMPs. Disruption of the balance causes various pathologies. The aim of the study is to elucidate the effects of sleep disturbance on matrix metalloproteinases and inhibitors by comparing MMP-2/TIMP-2 and MMP-9/TIMP-1 ratio in the serum of patients with chronic insomnia to healthy controls. Materials and Methods: This study included 40 adult males diagnosed with chronic insomnia and 40 healthy individuals as a control group. Blood samples were obtained from the brachial vein and subsequently centrifuged at 2,000 rpm for 15 minutes to collect serum samples. MMP-2, MMP-9, TIMP-1, and TIMP-2 levels were analyzed using commercial Enzyme-linked immunosorbent assay (ELISA) kit protocols with the obtained serum samples. Results: Consequently, in this study it was demonstrated a higher MMP-2/TIMP-2 ratio in chronic insomnia patients when compared to healthy controls, whereas the MMP-9/TIMP-1 ratio remained unchanged. Conclusion: These results suggest that higher MMP2/TIMP2 ratio may potentially contribute to the pathogenesis of diseases associated with sleep deprivation. [ABSTRACT FROM AUTHOR]

Eighty patients with chronic insomnia and 50 normal controls were selected. Evaluation scales included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep, Montreal Cognitive Assessment, Self-Rating Anxiety Scale, Self-Rating Depression Scale, Ruminative Responses Scale and Social Disability Screening Schedule. All patients and controls underwent whole-brain DTI scanning and Tract-Based Spatial Statistics (TBSS) analysis was performed. Chronic insomnia patients are mainly accompanied by white matter lesions of right posterior thalamic radiation, right sagittal tract, and right upper longitudinal tract. TBSS is helpful in the diagnosis of chronic insomnia and can reflect the changes of cognitive function. [ABSTRACT FROM AUTHOR]

Social restriction measures (SRM) implemented during the COVID-19 pandemic led to a reduction in time spent outdoors (TSO). The aim of this study was to describe TSO and evaluate its association with sleep outcomes, optimism, happiness and health-status before and during SRM. Two online surveys were conducted in 2017 (N = 1004) and 2020, during SRM (N = 1010), in samples representative of the age, sex and region of the Austrian population. Information on the duration of TSO, sleep, optimism, happiness and health-status was collected. Multivariable-adjusted logistic regression models were used to study the association of TSO with chronic insomnia, short sleep, late chronotype, optimism, happiness and self-rated health-status. The mean TSO was 3.6 h (SD: 2.18) in 2017 and 2.6 h (SD: 1.87) during times of SRM. Men and participants who were older, married or in a partnership and lived in a rural area reported longer TSO. Participants who spent less time outdoors were more likely to report short sleep or a late chronotype in both surveys and, in 2020, also chronic insomnia. Less TSO was associated with lower happiness and optimism levels and poor health-status. Our findings suggest that TSO may be a protective factor for sleep, mood and health, particularly during stressful and uncertain times. [ABSTRACT FROM AUTHOR]

Chronic insomnia is an inflammatory-related disease with an important pathological basis for various diseases which is a serious threat to a person's physical and mental health. So far, many hypotheses have been proposed to explain the pathogenesis of insomnia, among which inflammatory mechanisms have become the focus of scientific attention. In this regard, the aim of the present scooping review is to evaluate the potential benefits of natural compounds in treatment of chronic insomnia targeting nucleotide-binding oligomerization domain (NOD)-like receptor-pyrin-containing protein 3 (NLRP3)/caspase-1/IL-1β axis as one of the most important activators of inflammatory cascades. The data show that compounds that have the potential to cause inflammation induce sleep disorders, and that inflammatory mediators are key molecules in regulating the sleep-related activity of neurons. In the inflammatory process of insomnia, the role of NLRP3 in the pathogenesis of insomnia has been gradually considered by researchers. NLRP3 is an intracellular sensor that recognizes the widest range of pathogen-associated molecular patterns (PAMPs) and danger-associated molecular patterns (DAMPs). After identification and binding to damage factors, NLRP3 inflammasome is assembled to activate the caspase-1 and IL-1β. Increased production and secretion of IL-1β may be involved in central nervous system dysregulation of physiological sleep. The current scooping review reports the potential benefits of natural compounds that target NLRP3 inflammasome pathway activity and highlights the hypothesis which NLRP3 /caspase-1/IL-1β may serve as a potential therapeutic target for managing inflammation and improving symptoms in chronic insomnia. [ABSTRACT FROM AUTHOR]

Despite the well-established treatment effectiveness of exercise, cognitive behavioral therapy for insomnia (CBT-I), and pharmacotherapy on improving sleep, there have been no studies to compare their long-term effectiveness, which is of clinical importance for sustainable management of chronic insomnia. This study compared the long-term effectiveness of these three interventions on improving sleep in adults with chronic insomnia. MEDLINE, PsycINFO, Embase, and SPORTDiscus were searched for eligible reports. Trials that investigated the long-term effectiveness of these three interventions on improving sleep were included. The post-intervention follow-up of the trial had to be ≥6 months to be eligible. The primary outcome was the long-term effectiveness of the three interventions on improving sleep. Treatment effectiveness was the secondary outcome. A random-effects network meta-analysis was carried out using a frequentist approach. Thirteen trials were included in the study. After an average post-intervention follow-up period of 10.3 months, both exercise (SMD, −0.29; 95% CI, −0.57 to −0.01) and CBT-I (−0.48; −0.68 to −0.28) showed superior long-term effectiveness on improving sleep compared with control. Temazepam was the only included pharmacotherapy, which demonstrated superior treatment effectiveness (−0.80; −1.25 to −0.36) but not long-term effectiveness (0.19; −0.32 to 0.69) compared with control. The findings support the use of both exercise and CBT-I for long-term management of chronic insomnia, while temazepam may be used for short-term treatment. [ABSTRACT FROM AUTHOR]

Objectives: Involuntary job loss is a stressful life event that can result in changes in nutritional intake. Both insomnia and obstructive sleep apnea (OSA) also are associated with alterations in dietary intake, but the extent to which this occurs in those who have experienced involuntary job loss is unclear. This study assessed nutritional intake in recently unemployed persons with insomnia and obstructive sleep apnea in comparison to those without a sleep disorder. Methods: Participants from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study were screened for sleep disorders using the Duke Structured Interview for Sleep Disorders. They were classified as having OSA, acute or chronic insomnia or no sleep disorder. Dietary data was collected using United States Department of Agriculture Multipass Dietary recall methodology. Results: A total of 113 participants had evaluable data and were included in this study. The cohort was comprised mainly of women (62%) and 24% were non-Hispanic white. Participants with OSA had a higher BMI compared with no sleep disorder (30.6 ± 9.1 vs 27.4 ± 7.1 kg/m2, p≤0.001). Those with acute insomnia had significantly decreased consumption of total protein (61.5 ± 4.7 vs. 77.9 ± 4.9 g, p≤0.05) and total fat (60.0 ± 4.4 vs. 80.5 ± 4.6 g, p≤0.05). Among the participants with chronic insomnia, there was little overall difference in nutrient consumption compared to the no sleep disorder group although there were several gender specific differences. There were no overall differences between participants with OSA in comparison to no sleep disorder, but women consumed less total fat (89.0 ± 6.7 vs. 57.5 ± 8.0 g, p≤0.01). The Healthy Eating Index of all groups was below the average value of Americans. Conclusion: Unemployed persons compared to those with sleep disorders differ in their consumption of major nutrients; the dietary composition of those with acute insomnia exhibited the greatest divergence. Additionally, the overall nutritional intake of recently unemployed persons is poor.

A growing body of literature suggests that cytokines can play an important role in chronic insomnia disorder (CID); however, the underlying mechanisms are still unknown. Here we show that serum levels of pro-inflammatory mediators including IL-12, IFN-γ and ICAM-1 are elevated in CID group when compared with healthy controls, and that the REM sleep duration diminishes with increased concentrations of IL-12 and IFN-γ in individuals with CID. Furthermore, we find that lowered serum concentration of IL-1ra is negatively correlated with severity of insomnia in CID group. These data add to the evidence that the imbalance of circulating pro-inflammatory mediators IL-12, IFN-γ, and ICAM-1 and anti-inflammatory cytokine IL-1ra is important in CID pathogenesis. • The significant reduction in IL-1ra was correlated with decline in sleep quality in CID group. • The elevated levels of IL-12 and IFN-γ were associated with decline in REM duration in chronic insomnia disorder. • The imbalance of pro-inflammatory and anti-inflammatory factors may play an important role in the pathogenesis of insomnia. [ABSTRACT FROM AUTHOR]

Background: Functional abnormalities of the cerebellum have been found to be closely associated with chronic insomnia (CI). However, whether there are abnormalities in the topology of the functional connectome of the cerebellum in these patients is still unknown. This study aimed to investigate topological abnormalities of the cerebellar functional connectome in individuals with CI. Materials and Methods: We used resting‐state functional magnetic resonance imaging (rs‐fMRI) and graph‐theoretic analysis to construct a functional connectivity matrix and extract topological property features of the cerebellar functional connectome in patients with CI. We examined global and nodal topological property changes in the cerebellar functional connectome in 102 patients with CI (CI group) and 101 healthy participants without insomnia symptoms (HC group) to determine the differences between groups. Correlations between the topological properties of the cerebellar functional connectome and clinical assessments were calculated to confirm the differences between groups. Results: The cerebellar functional connectome of both CI and HC patients exhibited small‐world properties. The CI group showed higher standardized clustering coefficients at the global properties and higher betweenness centrality in the cerebellar Crus II vermis region at the nodal properties compared with participants in the HC group. However, the topological properties of cerebellar functional connectome abnormalities in the CI group were not significantly different from those in clinical assessments. Conclusion: Our findings suggest that the abnormal global and nodal topological properties of the cerebellar functional connectome are associated with CI and could serve as an important biomarker for CI. [ABSTRACT FROM AUTHOR]

Study objectives: To study the effectiveness of the first internet-based cognitive behavioral therapy for insomnia (CBT-i) in Thailand, using the Nitra application, for chronic subthreshold to moderate insomnia treatment. Methods: An interventional study without a control group was conducted between January and June 2022. Participants were adults aged 18 years old and older with subthreshold to moderate severity of chronic insomnia (insomnia severity index (ISI) of 8-21) and had mean sleep efficiency <85% from baseline sleep diaries. Baseline sleep characteristics were obtained from questionnaires and sleep diaries from the Nitra application for 2 weeks. Eligible participants continued using the Nitra application for 4 weeks during the intervention period. Interventions including sleep restriction, stimulus control, cognitive restructuring, relaxation techniques, and sleep hygiene education were implemented via the pre-programmed Nitra application. Post-intervention sleep characteristics were also obtained from questionnaires and sleep diaries from the Nitra application for another 1 week. Results: A total of 40 participants completed the study. All participants had a baseline sleep efficiency of less than 85% with the majority of the participants having a sleep-onset insomnia problem (98%). For the primary outcome, sleep efficiency was significantly improved after using the Nitra application (p < 0.001). Self-reported total sleep time, sleep onset latency, wake after sleep onset, early morning awakening, ISI, Pittsburgh Sleep Quality Index (PSQI), and average subjective sleep quality were also significantly improved (p < 0.001 for all parameters except p = 0.017 for total sleep time and p = 0.018 for wake after sleep onset). Participants who had a low baseline ISI and went to bed and woke up within 30 minutes of a designated bedtime and wake-up time recommended by the Nitra application for =70% of all nights demonstrated an increased chance of achieving normal sleep efficiency after using the Nitra application. Conclusion: This first internet-based CBT-i in Thailand, using the Nitra application, effectively improved sleep efficiency and other sleep parameters in chronic subthreshold to moderate insomnia. [ABSTRACT FROM AUTHOR]

Objective: Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder. Despite strong evidence supporting the efficacy of CBT-I, a limited number of studies investigated dropout-related factors during treatment. This study aims to test the efficacy of CBT-I and to provide an assessment of predictors for drop-out to treatment in a sample of young adults with chronic insomnia. Method: A total of 86 young adult patients with chronic insomnia (mean age 24.85 ± 3.83 years, 51 females (59.3%)) were assessed before and after CBT-I with a sleep diary and a battery of questionnaires designed to investigate insomnia severity (Insomnia Severity Index, ISI), sleepiness, dysfunctional sleeprelated thoughts, chronotype, depressive symptoms, and perceived stress. Those patients who interrupted therapy before the fourth session were classified as drop-outs. In addition, patients with an ISI decrease ≥ 8 were classified as responders, and patients with a final ISI total score < 8 were classified as remitters. Results: The results showed significant improvements after treatment in insomnia severity and sleep diaries indices, except for total sleep time. Evening chronotype and prolonged sleep onset latency predicted drop-out from treatment. Vice versa, a high number of awakenings was associated with a higher response rate to CBT-I. Similarly, a reduction in sleepiness, sleep-related dysfunctional thoughts, and an increase in total sleep time were associated with symptom remission. Conclusions: A tailored treatment focused on the application of behavioral strategies appropriate for evening chronotype in young adult patients could reduce the drop-out rate. [ABSTRACT FROM AUTHOR]

Background: The treatment of insomnia, which is the most common sleep disorder, includes drug and behavioral treatment, but each treatment measure has its limitations. So new treatment method needs to be taken to improve the treatment effect. MN supplementation is a potential promising new method for the treatment of insomnia, resulting in a rising need for methodological research towards verifying its efficacy. Methods/design: We describe a proposal for a multicenter, patient-assessor-blinded, randomized controlled trial with two parallel arms. A total of 400 chronic insomnia patients will be allocated 1:1 to the intervention group (treatment with oral NMN 320 mg/day) or control group (treatment with oral placebo). All subjects are clinical chronic insomnia patients who meet all inclusion criteria. All subjects are treated by taking NMN or placebo. The primary outcome is the score on the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes are the score on the Insomnia Severity Index (ISI) and Epworth Sleeping Scale (ESS), the total sleep time (TST), sleep efficiency (SE), sleep latency, and REM sleep latency to assess sleep quality changes. Subjects are assessed at two time points: baseline and follow-up. The duration of the clinical trial is 60 days. Discussion: This study will provide more evidence on the effects of NMN on improving sleep quality among patients with chronic insomnia. If proven effective, NMN supplement can be used as a new treatment for chronic insomnia in the future. Trial registration: Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR2200058001. Registered on 26 March 2022. [ABSTRACT FROM AUTHOR]

This plain language summary describes the main results from two similar research studies, "Study 1" and "Study 2", which evaluated the use of a medication called daridorexant in patients with chronic insomnia disorder. These two studies were phase 3 clinical trials, which compared different doses of daridorexant to an inactive pill called a placebo, which looked and tasted similar to the daridorexant pill but did not contain daridorexant or any other active ingredient. Adults with chronic insomnia disorder typically find it hard to fall or stay asleep and may wake up too early, leading to sleep dissatisfaction. They also have impaired daytime functioning, which is when a person can feel tired or drowsy, have difficulty concentrating, or experience low mood as a consequence of lack of sleep. Adults with chronic insomnia disorder are also at increased risk for injuries and accidents as a result of that impaired daytime functioning. Researchers found that daridorexant 50 mg and 25 mg improved on average participants' ability to get to sleep and stay asleep, as well as increasing their overall total sleep time. Daridorexant 50 mg also improved daytime functioning without any negative effects the next morning, such as feeling tired or drowsy, on average in the participants included in the studies. While available medications are effective in treating night-time symptoms of insomnia, they have not been shown to improve daytime symptoms in insomnia, and in many cases have been shown to have residual effects the next day due to their nature as sedatives. Therefore there has been a need for new treatments for chronic insomnia disorder that will improve both night-time and daytime symptoms with minimal next morning effects. These findings show the effectiveness of daridorexant 50 mg in improving both night-time and daytime functioning, and that daridorexant is well-tolerated at all doses. The results from these two studies resulted in the approval of the 25 mg and 50 mg doses of daridorexant by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Clinical Trial Registration:NCT03545191 (study 1) and NCT03575104 (study 2) (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

Background/Objective: Insomnia is a prevailing health problem among older adults. Tai Chi, a popular mind-body exercise practiced by older people in various oriental communities, has been shown to improve sleep. However, Tai Chi has not been directly compared to cognitive behavioral therapy for insomnia (CBT-I), which is the first-line non-pharmacological treatment for insomnia in older adults. This study aims to examine whether Tai Chi is non-inferior to CBT-I as a treatment for insomnia in older adults. Methods: This is a single-center, assessor-blinded, non-inferiority randomized controlled trial comparing Tai Chi and CBT-I in 180 older adults aged ≥50 years with chronic insomnia according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Participants will be randomly assigned to either the Tai Chi or CBT-I group. Interventions will last for 3 months with a 12-month follow-up. The primary outcome is self-perceived insomnia severity measured by Insomnia Severity Index (ISI) at 3 months and at 15 months. The secondary outcomes include the remission rate of chronic insomnia, insomnia treatment response, subjective sleep quantity and quality, 7-day actigraphy, 7-day sleep diary, sleep medication, health-related quality of life, mental health, body balance and lower extremity function, adverse events, habitual physical activity, and dietary intake. Measurements will be conducted at baseline, 3 months, and 15 months by outcome assessors who are blinded to the group allocation. Discussion: This will be the first non-inferiority randomized controlled trial to compare the efficacy and long-term outcomes of Tai Chi versus CBT-I for treating insomnia in older adults. This study will be of clinical importance as it supports the use of Tai Chi as an alternative non-pharmacological approach for insomnia treatment and sustainable management.

Objective To investigate the therapeutic mechanism of Bian-shi therapy in improving sleep quality in young and middle-aged patients with chronic insomnia. Methods 40 young and middle-aged patients with chronic insomnia were randomly divided into the western medicine group （n = 20） and Bian-shi group （n = 20）. In the western medicine group， patients were orally treated with zopiclone （7.5 mg， oral administration before bedtime）， and those in the Bian-shi group were treated with placebo and Bian-shi therapy （once a week， 40 min a time， 4 times in total）. The changes of Pittsburgh Sleep Quality Index （PSQI）， and serum melatonin， acetylcholine and norepinephrine before and after 30 d treatment were analyzed and compared between two groups. Results After 30 d treatment， PSQI scores were significantly lower compared with those before treatment in two groups （both P < 0.05）. In the Bian-shi group， PSQI scores were more significantly decreased than those in the western medicine group （all P < 0.05）. After 30 d treatment， serum levels of melatonin and acetylcholine were significantly higher， whereas norepinephrine levels were significantly lower than those before treatment in two groups （all P < 0.05）. In the Bian-shi group， serum levels of melatonin and acetylcholine were significantly higher， whereas norepinephrine levels were significantly lower compared with those in the western medicine group （all P < 0.05）. Conclusions Bian-shi therapy can effectively improve the sleep quality of young and middle-aged patients with chronic insomnia， which yields higher clinical efficacy than that of zopiclone tablets. Multiple neurotransmitters may be involved in the mechanism of Bian-shi therapy to mitigate chronic insomnia symptoms.