Search

Summary: Insomnia is a primary symptom of shift work disorder, yet it remains undertreated. This randomised‐controlled pilot trial examined the efficacy of a digital, guided cognitive behavioural therapy for insomnia adapted to shift work (SleepCare) in nurses with shift work disorder. The hypothesis was that SleepCare reduces insomnia severity compared with a waitlist control condition. A total of 46 unmedicated nurses suffering from shift work disorder with insomnia (age: 39.7 ± 12.1 years; 80.4% female) were randomised to the SleepCare group or the waitlist control group. The primary outcome measure was the Insomnia Severity Index. Other questionnaires on sleep, mental health and occupational functioning, sleep diary data and actigraphy data were analysed as secondary outcomes. Assessments were conducted before (T0), after the intervention/waitlist period (T1), and 6 months after treatment completion (T2). The SleepCare group showed a significant reduction in insomnia severity from T0 to T1 compared with the control condition (β = −4.73, SE = 1.12, p < 0.001). Significant improvements were observed in sleepiness, dysfunctional beliefs about sleep, pre‐sleep arousal, sleep effort, self‐reported sleep efficiency and sleep onset latency. No significant effect was found in actigraphy data. Depressive and anxiety symptoms, cognitive irritation and work ability improved significantly. Overall, satisfaction and engagement with the intervention was high. SleepCare improved insomnia severity, sleep, mental health and occupational functioning. This is the first randomised‐controlled trial investigating the efficacy of digital cognitive behavioural therapy for insomnia in a population suffering from shift work disorder with insomnia. Future research should further explore these effects with larger sample sizes and active control conditions. [ABSTRACT FROM AUTHOR]

Background: Sleep helps in improving the functions of all systems of human body. Disturbance in sleep can cause immediate adverse effects on normal human physiologic functions. Main objective of this study was to explore the psychometric properties of the Dari version of the of Pittsburgh Sleep Quality Index (PSQI) among general adult population of Afghanistan. Methods: This methodological study has been conducted during July to November 2023. Reliability and validity of PSQI were evaluated using Cronbach's Alpha and confirmatory factor analysis, respectively. Pearson correlation analysis was conducted to assess the convergent validity of the components of PSQI, comparing results with those obtained from the DASS-21 subdomains. Results: In this cross-sectional study, 965 Afghan adults were studied during five months of duration between July and November, 2023. Mean age of the study participants was 35.2 years. The prevalence of sleep disturbance was 44.6% (430/965). Among them, 59.3% (572/965) reported experiencing subjective sleep quality disturbances less than once a week, 36.2% (349/965) had sleep latency issues less than once a week, 17.6% (170/965) had sleep duration disruption once or twice a week, while 36.3% (350/965) had daytime dysfunction less than once a week. The Cronbach's alpha coefficient for the seven-component scale was 0.677, indicating acceptable internal consistency. Substantial and statistically significant positive correlations were present among the component of PSQI subjective sleep quality and sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, daytime dysfunction, DASS-Depression, DASS-Anxiety, and DASS-Stress. The overall PSQI exhibited favorable fit indices, supporting the proposed single-factor structure among adult Afghan population. Conclusion: Prevalence of sleep disturbance was very high among adult population of Afghanistan. This study provided useful information that will help policy makers (such as ministry of public health as well as international donor agencies like WHO, USAID, and UNICEF) to design a better strategy to reduce the prevalence of sleep disturbance that affects health of the Afghan community at large. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to systematically assess the clinical efficacy of non-invasive brain stimulation (NIBS) for treating post-stroke sleep disorders (PSSD). Methods: We conducted thorough literature search across multiple databases, including PubMed, Web of Science, EmBase, Cochrane Library, Scopus, China Biology Medicine (CBM); China National Knowledge Infrastructure (CNKI); Technology Periodical Database (VIP), and Wanfang Database, focusing on RCTs examining NIBS for PSSD. Meta-analyses were performed using RevMan 5.4 and Stata 14. Results: Eighteen articles were reviewed, including 16 on repetitive Transcranial Magnetic Stimulation (rTMS), one on Theta Burst Stimulation (TBS), and two on transcranial Direct Current Stimulation (tDCS). Meta-analysis results indicated that rTMS within NIBS significantly improved the Pittsburgh Sleep Quality Index (PSQI) score (MD = −1.85, 95% CI [−2.99, −0.71], p < 0.05), the 17-item Hamilton Depression Rating Scale (HAMD-17) score [MD = −2.85, 95% CI (−3.40, −2.30), p < 0.05], and serum brain-derived neurotrophic factor (BDNF) levels [MD = 4.19, 95% CI (2.70, 5.69), p < 0.05], while reducing the incidence of adverse reactions [RR = 0.36, 95% CI (0.23, 0.55), p < 0.05]. TBS significantly improved the PSQI score in patients with PSSD (p < 0.05). Conversely, tDCS significantly improved the HAMD-17 score in PSSD patients [MD = −1.52, 95% CI (−3.41, −0.64), p < 0.05]. Additionally, rTMS improved sleep parameters, including Stage 2 sleep (S2%) and combined Stage 3 and 4 sleep (S3 + S4%) (p < 0.05), while tDCS improved total sleep time (TST) and sleep efficiency (SE) (p < 0.05).Subgroup analysis results indicated: (1) Both LF-rTMS and HF-rTMS improved PSQI scores (p < 0.05). (2) Both rTMS combined with medication and rTMS alone improved PSQI scores (p < 0.05). Compared to the sham/blank group, the rTMS group showed improvements in SE, sleep latency (SL), S1%, S3 + S4%, and REM sleep (REM%). The rTMS combined with medication group showed improved SL compared to the medication-only group (p < 0.05). Conclusion: NIBS effectively improves sleep quality, structure, depression levels, and BDNF levels in PSSD patients, while also being safe. Further investigations into the potential of NIBS in PSSD treatment may provide valuable insights for clinical applications. Systematic review registration: https://www.crd.york.ac.uk/prospero/, CRD42023485317. [ABSTRACT FROM AUTHOR]

Introduction: The normal transition to sleep is characterized by a reduction in higher frequency activity and an increase in lower frequency activity in frontal brain regions. In sleep onset insomnia these changes in activity are weaker and may prolong the transition to sleep. Methods: Using a wearable device, we compared 30min of short duration repetitive transcranial electric stimulation (SDR-tES) at 0.75Hz, prior to going to bed, with an active control at 25Hz in the same individuals. Results: Treatment with 0.75Hz significantly reduced sleep onset latency (SOL) by 53% when compared with pre-treatment baselines and was also significantly more effective than stimulation with 25Hz which reduced SOL by 30%. Reductions in SOL with 25Hz stimulation displayed order effects suggesting the possibility of placebo. No order effects were observed with 0.75Hz stimulation. The decrease in SOL with 0.75Hz treatment was proportional to an individual's baseline wherein those suffering from the longest pre-treated SOLs realized the greatest benefits. Changes in SOL were correlated with left/right frontal EEG signal coherence around the stimulation frequency, providing a possible mechanism and target for more focused treatment. Stimulation at both frequencies also decreased perceptions of insomnia symptoms measured with the Insomnia Severity Index, and comorbid anxiety measured with the State Trait Anxiety Index. Discussion: Our study identifies a new potential treatment for sleep onset insomnia that is comparably effective to current state-of-practice options including pharmacotherapy and cognitive behavioral therapy and is safe, effective, and can be delivered in the home. [ABSTRACT FROM AUTHOR]

Background: Patients with head and neck cancer often experience impaired sleep. Moreover, the treatment may negatively affect sleep quality. The aim of this observational study was to evaluate the sleep quality after treatment for head and neck cancer, and its relationship with quality of life and psychological distress. Methods: A total of 151 patients who underwent treatment for head and neck cancer at our department were included in the study. Quality of life, sleep quality, risk of sleep apnea, sleepiness, pain, and psychological distress were assessed by means of specific questionnaires. Results: The median follow-up was 30 months. Poor sleep quality was observed in 55.6% of the cases. An association between PSQI global sleep quality and EORTC global health status was found. The DT, HADS anxiety, and HADS depression scores were associated to PSQI global score, sleep quality, sleep latency, sleep disturbances, and daytime dysfunction. Conclusions: Sleep disturbances, particularly OSA and insomnia, are frequent in HNC patients, and significantly impact their quality of life and psychological well-being. Given the effect of sleep on overall well-being, addressing sleep disorders should be a priority in the care of HNC patients. [ABSTRACT FROM AUTHOR]

Insomnia is common in children with autism spectrum disorder (ASD). We recently developed and validated the 21-item Pediatric Autism Insomnia Rating Scale (PAIRS). This report explores the associations and agreements between actigraphy and PAIRS. Children with ASD, with and without sleep problems, were assessed with a battery of parent-rated and clinician measures (N = 134). In a subset (n = 70), a wrist-worn actigraph measured sleep for five consecutive nights. Parents completed logs for scoring sleep intervals. Spearman correlations evaluated associations with the PAIRS and actigraphy indices (sleep onset latency = SOL, wake after sleep onset = WASO, total sleep time = TST, sleep efficiency = SE%). Agreements on "poor sleepers" based on PAIRS total score (≥33) and conventional thresholds for TST and SE% were evaluated with Cohen's Kappa and McNemar's test. Actigraphy data were averaged over 4.64 ± 0.68 nights in 70 children (mean age = 7.3 ± 2.9, 74.3 % male). There were no significant correlations between PAIRS and any actigraphy indices. On TST, 48.6 % (n = 34) and on SE% 52.9 % (n = 37) were classified as "poor sleepers" compared to 32.9 % (n = 23) on PAIRS (kappa = 0.11 for TST and 0.27 for SE%). P-values on McNemar's Chi square test for PAIRS with TST and with SE% were 0.072 and 0.011, respectfully. These results suggest that actigraphy and PAIRS do not agree. Actigraphy TST captures movement and an estimate of specific sleep parameters. PAIRS is a broader measure that incorporates sleep disturbance and sleep-related impairment. [ABSTRACT FROM AUTHOR]

The current study aims to assess the effects of abrine (ABR) in thiopental sodium (TS)‐induced sleeping mice and to explore the sedative impacts of the compound by using in vivo and in silico investigations. ABR (5 and 10 mg k−1g, i.p.) and diazepam (DZP) (2 mg k−1g, i.p.) were administered to the experimental animals either single or combined. TS (20 mg k−1g, i.p.) was administered to induce sleep, and latency with sleeping duration was observed for 3 h. The in silico investigation was conducted to predict the role of ABR in the gamma‐aminobutyric acid A (GABAA) receptor in the sleeping process and to evaluate pharmacokinetics and toxicity. Results showed that ABR (10 mg k−1g) significantly (p < 0.05) decreased the latency period (8.20 ± 1.85 min) and enhanced sleep duration (187.8 ± 8.87 min) in comparison with the control group. Additionally, the co‐treatments of ABR and DZP remarkably reduced the latency period (4.40 ± 0.24 min) and increased the sleeping duration (201.40 ± 5.89 min) compared to the single therapy. The molecular docking indicated that ABR has a binding affinity of −7.4 kcal/mol for the GABAA receptor. In conclusion, ABR provides strong sedative and synergistic efficacy on TS‐induced sleeping mice via the GABAergic system. [ABSTRACT FROM AUTHOR]

There is growing enthusiasm towards the role of smartphone app-based interventions in the management of insomnia and related sleep problems. A considerable number of apps designed to address insomnia have been developed in recent years, and randomized controlled trials (RCTs) have begun to explore their efficacy. We conducted a meta-analysis investigating the effectiveness of apps for insomnia and sleep disturbances. From 19 RCTs, we identified significant pooled effect sizes for the primary outcomes of self-reported insomnia (g = 0.60; 05 % CI = 0.44, 0.76; NNT = 4.8) and sleep disturbances (g = 0.70; 95 % CI = 0.58, 0.83; NNT = 4.1) in favour of apps over control conditions. These effects remained robust when restricting the analyses to trials that delivered a placebo control, received a lower risk of bias rating, and had a larger sample size. Significant pooled effects in favour of apps were also observed for secondary outcomes of night time awakenings (g = 0.56), total sleep time (g = 0.33), and sleep onset latency (g = 0.32), but non-significant effects emerged for daytime sleepiness, dysfunctional beliefs about sleep, sleep efficiency, sleep hygiene, and wake after sleep onset. The pooled dropout rate from app conditions was 13.1 % (95 % CI = 8.3, 20.0), which was significantly higher than control conditions (OR = 1.78, 95 % CI = 1.39, 2.28). Findings suggest that stand-alone app-based interventions can effectively address insomnia and sleep disturbances, and may play an important role in the management of these symptoms. • Conducted a meta-analysis of 19 randomized trials of app-based interventions for insomnia. • Apps produced medium-large effects over controls on insomnia and sleep disturbances. • Apps may play an important role in the management of sleep disturbances. [ABSTRACT FROM AUTHOR]

This Phase 3 double-blind, placebo-controlled study evaluated the efficacy and safety of daridorexant in Japanese patients with insomnia disorder. 490 patients with insomnia disorder from 95 sites in Japan were randomized to daridorexant 50 mg (n = 163), 25 mg (n = 163) or placebo (n = 164) for 4 weeks, followed by a 7-day placebo run-out and a 30-day safety follow-up. The primary efficacy endpoints, in hierarchical order, were change from baseline at Week 4 in subjective total sleep time (sTST) and subjective latency to sleep onset (sLSO), for daridorexant 50 mg vs placebo. sTST and sLSO were also evaluated (secondary endpoints) for daridorexant 25 mg vs placebo. Safety endpoints included adverse events and next-morning sleepiness (Visual Analog Scale, VAS). Daridorexant 50 mg significantly increased sTST and decreased sLSO versus placebo at Week 4 (least-squares mean difference [LSMD]: sTST 20.3 min [95 % CI 11.4, 29.2] p < 0.001; sLSO −10.7 min [−15.8, −5.5] p < 0.001). Daridorexant 25 mg also significantly improved both endpoints versus placebo (LSMD: sTST 9.2 min [0.3, 18.1] p = 0.042; sLSO −7.2 min [-12.3, −2.0] p = 0.006). Overall incidence of adverse events was similar across groups (50 mg: 22 %; 25 mg: 18 %; placebo 23 %); somnolence, the most common event, increased with increasing dose (50 mg: 6.8 %; 25 mg: 3.7 %; placebo 1.8 %). However, daridorexant did not increase VAS next-morning sleepiness. No rebound or withdrawal-related symptoms were observed after treatment discontinuation. In Japanese patients with insomnia disorder, daridorexant (25 and 50 mg) was well tolerated and significantly improved subjective sleep outcomes, with no evidence of residual effects. • The efficacy and safety of daridorexant in Japanese patients with insomnia was evaluated. • Over 4 weeks, daridorexant was effective for all subjective sleep parameters assessed. • Daridorexant was well tolerated and not associated with any residual effect. [ABSTRACT FROM AUTHOR]

The short-term efficacy and safety of daridorexant, a dual orexin receptor antagonist, has been demonstrated in Japanese patients with insomnia disorder. The objective of this study was to evaluate, in a non-overlapping patient population to the short-term study, the long-term safety and efficacy of daridorexant in Japanese patients with insomnia disorder. In this Phase 3 open-label study conducted in Japan, 154 patients with insomnia disorder were randomized to daridorexant 50 mg (n = 102) or 25 mg (n = 52) for 52 weeks. The primary objective was to assess the safety and tolerability of daridorexant for up to 1 year. Secondary exploratory objectives were to evaluate the long-term efficacy of daridorexant on subjective sleep parameters (total sleep time, latency to sleep onset and wake after sleep onset) and daytime functioning (Insomnia Daytime Symptoms and Impacts Questionnaire). The incidence of treatment-emergent adverse events (TEAEs) was 74 % and 58 % in the 50 mg and 25 mg groups respectively. No serious drug-related TEAEs were reported. Both doses improved next-morning sleepiness (Visual Analog Scale) throughout the study. Five adjudicated adverse events of special interest were reported; excessive daytime sleepiness (n = 1, 25 mg; n = 2, 50 mg), sleep paralysis (n = 1, 50 mg) and nightmare (n = 1, 25 mg). Improvements in sleep and daytime functioning were maintained from Week 2 (first assessment) through to Week 52 in both dose groups. Up to 52-weeks, daridorexant was well tolerated with sustained improvement in sleep onset, sleep maintenance and daytime functioning, supporting its long-term use in Japanese patients with insomnia disorder. • In Japanese patients with insomnia disorder daridorexant was safe for up to 1 year. • Daridorexant sustained improvements in nighttime sleep and daytime functioning. • These results support the use of daridorexant as a long-term early treatment option for patients with insomnia disorder in Japan. [ABSTRACT FROM AUTHOR]

Objective: To assess efficacy of Chinese medicine (CM) on insomnia considering characteristics of treatment based on syndrome differentiation. Methods: A total of 116 participants aged 18 to 65 years with moderate and severe primary insomnia were randomized to the placebo (n=20) or the CM group (n=96) for a 4-week treatment and a 4-week follow-up. Three CM clinicians independently prescribed treatments for each patient based on syndromes differentiation. The primary outcome was change in total sleep time (TST) from baseline. Secondary endpoints included sleep onset latency (SOL), wake time after sleep onset (WASO), sleep efficiency, Pittsburgh Sleep Quality Index (PSQI) and CM symptoms. Results: The CM group had an average 0.6 h more (95% confidence interval (CI): 0.3–0.9, P<0.001) TST and 34.1% (10.3%–58.0%, P=0.005) more patients beyond 0.5 h TST increment than that of the placebo group. PSQI was changed −3.3 (−3.8 to −2.7) in the CM group, a −2.0 (−3.2 to −0.8, P<0.001) difference from the placebo group. The CM symptom score in the CM group decreased −2.0 (−3.3 to −0.7, P=0.003) more than the placebo group. SOL and WASO changes were not significantly different between groups. The analysis of prescriptions by these clinicians revealed blood deficiency and Liver stagnation as the most common syndromes. Prescriptions for these clinicians displayed relative stability, while the herbs varied. All adverse events were mild and were not related to study treatment. Conclusion: CM treatment based on syndrome differentiation can increase TST and improve sleep quality of primary insomnia. It is effective and safe for primary insomnia. In future studies, the long-term efficacy validation and the exploratory of eutherapeutic clinicians' fixed herb formulas should be addressed (Registration No. NCT01613183). [ABSTRACT FROM AUTHOR]

Summary The present study aims at identifying sleep patterns in insomnia in a clinical sample using three strategies to define poor nights. Sleep diaries and self‐reported questionnaires were collected from 77 clinical patients with insomnia. The conditional probabilities of observing a poor night after 1, 2, or 3 consecutive poor nights were computed according to three strategies with same criteria for sleep onset latency, wake after sleep onset, and sleep efficiency, but varying criterion for total sleep time. Latent profile analyses were conducted to derive sleep patterns. Uni‐ and multivariate analyses were conducted to characterise the sleep patterns identified. A total of 1586 nights were analysed. The strategy used significantly influenced the average percentage of reported poor nights. Two to three sleep patterns were derived per strategy. Within each strategy, sleep patterns differed from each other on sleep variables and night‐to‐night variability. Results suggest the existence of sleep patterns in insomnia among individuals consulting in psychological clinics. Adding a total sleep time of 6‐h cut‐off as a criterion to define poor nights increases the accuracy of the strategy to define poor night and allows to identify sleep patterns of poor nights in insomnia. [ABSTRACT FROM AUTHOR]

Objective: Sleep disturbance is common among individuals with eating disorders (EDs), with approximately 50% of patients with EDs reporting sleep disturbance. Sleep problems may promote, exacerbate, or maintain ED symptoms through a variety of hypothesized mechanisms, such as impaired executive function, increased negative affect, and disruptions to appetitive rhythms. Although research investigating the role of sleep in EDs is growing, the current literature suffers from methodological limitations and inconsistencies, which reduce our ability to translate findings to improve clinical practice. The purpose of this forum is to propose a coordinated approach to more seamlessly integrate sleep research into ED research with particular emphasis on best practices in the definition and assessment of sleep characteristics. Methods: In this article, we will describe the current status of sleep‐related research and relevant gaps within ED research practices, define key sleep characteristics, and review common assessment strategies for these sleep characteristics. Throughout the forum, we also discuss study design considerations and recommendations for future research aiming to integrate sleep research into ED research. Results/Discussion: Given the potential role of sleep in ED maintenance and treatment, it is important to build upon preliminary findings using a rigorous and systematic approach. Moving forward as a field necessitates a common lens through which future research on sleep and EDs may be conducted, communicated, and evaluated. [ABSTRACT FROM AUTHOR]

With the increasing prevalence of insomnia-related diseases, the effective treatment of insomnia has become an important health research topic. Lavender (Lavandula angustifolia Mill.) essential oil (LEO) is a commonly used medicine for the treatment of insomnia and neurological disorders. However, neither the active components nor its sedative–hypnotic mechanism have been fully discovered. This study aimed to screen the main active terpenes and discover the possible mechanism of LEO through network pharmacology in the treatment of insomnia-related diseases, as well as to verify our hypothesis in insomnia mice. The results showed that, in LEO's 15 potential active ingredients, beta-myrcene had strong sedative–hypnotic effects through the serotonergic synaptic pathway according to the network pharmacological prediction. Further, PCPA(DL-4-chlorophenylalanine)-induced insomnia mice were treated with beta-myrcene for one day or seven days. The quiet state of insomnia mice was increased effectively, and the hypnotic effect was enhanced by anaobarbital sodium by prolonging sleep duration, decreasing sleep latency, and increasing the rate of falling asleep. Beta-myrcene reduced the damage to hypothalamic neuron cells induced by PCPA and increased neurotransmitter levels of GABA, 5-HT, and Glu in the serum and hypothalamus of insomnia mice. Meanwhile, beta-myrcene exerted an improvement in insomnia by upregulating relevant genes and protein expression in the serotonergic synaptic pathway. These results support the merit of the sedative–hypnotic activity of LEO. Beta-myrcene, a terpene in LEO, may be the main source of its sedative–hypnotic properties. It may serve as a good potential compound in future clinical studies on coping with insomnia. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT). Aims: To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep. Method: Data was gathered from 179 participants with an anxiety disorder (11–17 years old) who had previously engaged with the out-patient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset (n =73) had outcome data, which was used to examine changes in sleep following CBT. Results: At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents' weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia. Conclusions: The study relied upon subjective measurement of sleep and there was no control group; however, the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems. [ABSTRACT FROM AUTHOR]

Objectives: Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism. Methods: Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected. Results: High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r =.26 to.88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions. Conclusions: Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one's vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia. [ABSTRACT FROM AUTHOR]

Daridorexant is approved for the treatment of insomnia at two dose levels (25 and 50 mg). Dose-efficacy and -safety response relationships were evaluated using Phase 2 and 3 data. Data (N = 2153) from one Phase 2 (daridorexant 5, 10, 25, 50 mg, placebo once daily for 1 month) and two Phase 3 studies (daridorexant 10 and 25 or 25 and 50 mg, placebo once daily for 3 months) were pooled. Dose-response analyses at 1 month of double-blind treatment were performed using a linear regression and a two-stage meta-analysis approach. Efficacy endpoints were polysomnography-derived wake after sleep onset, latency to persistent sleep (LPS), self-reported total sleep time and the Insomnia Daytime Symptoms and Impacts Questionnaire total score (only Phase 3 data for the latter). Safety endpoints were the incidence of total adverse events (AEs) and AEs corresponding to somnolence/fatigue. Dose-responses for all efficacy endpoints were significant in the observed dose range (both statistical approaches, p < 0.01). All dose-response relationships were linear except for LPS (two-stage meta-analysis) which showed a change in slope above 10 mg without reaching a plateau. No significant dose-response was observed for any AE (both approaches, p > 0.05). The incidence of AEs corresponding to somnolence/fatigue was low at all doses and, without linear assumption (two-stage meta-analysis) there was no dose-dependency (p = 0.369). The data support the use of 50 mg as the preferred daridorexant dose in patients with insomnia disorder to provide the greatest opportunity for efficacy with no increased risk for AEs, including somnolence/fatigue, compared to lower doses. • Analysis of Phase 2/3 data to evaluate the dose-response relationship of daridorexant. • Daridorexant showed a dose-response relationship on sleep and daytime functioning. • No evidence of a dose-response for adverse events, including somnolence/fatigue. • Results indicate a positive benefit-risk balance for daridorexant 25 mg and 50 mg. • Results support 50 mg as the preferred dose for insomnia disorder. [ABSTRACT FROM AUTHOR]

This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework. 177 participants (86.3 % female; M age = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up. Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses. Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients. • Lower HF-HRV was associated with worse pre-treatment sleep efficiency. • HF-HRV was not related to reduced insomnia symptoms following CBT-I. • HF-HRV reactivity was not associated to initial insomnia symptoms or CBT-I response. • HF-HRV may not be helpful in informing patients allocation to stepped-care treatments. [ABSTRACT FROM AUTHOR]

Objective. To test the hypothesis that there are differences between three mean values of sleep latency (SL) when falling asleep: when accompanied by audio stimuli based on binaural beats (BB), after listening to suggestive instructions on how to relax the body, and accompanied by BB-based audio stimuli after listening to suggestive instructions for relaxing the body (i.e., 1 and 2 combined). Materials and methods. A special app was written for the Android operating system for the purpose of conducting this study and was installed on subjects' individual smartphones. The app included a screen touch test as a control for falling asleep. Data were analyzed from 63 subjects who were presented with the three types of sound stimuli noted above in a counterbalanced design. Results. Statistical analysis confirmed the hypothesis noted above that the SL depended on the type of sound stimulus (p < 0.05). Pairwise comparison of SL showed significant differences between stimuli (3) (1149 ± 113 sec) and (1) (1469 ± 89 sec) (p < 0.01). The SL for stimulus (2) had an intermediate value of 1269 ± 112 sec (differing from stimulus (1) at the level of a trend). Conclusion. The use of a sound background consisting of BB enhances the effect of suggestive instructions in improving sleep. However, the decisive role belongs to suggestion as a psychotherapeutic technique. [ABSTRACT FROM AUTHOR]

Background: Shift workers are at an increased risk of developing sleep disorders. The standard therapy recommended for sleep disorders is cognitive behavioural therapy for insomnia (CBT-I). Many of its interventions are based on a regular sleep and wake rhythm, which is difficult to apply for shift workers. We have therefore developed a new therapy manual specifically for shift workers (CBT-I-S), which should be more applicable to their needs. In particular, all interventions that require regularity have been removed, and instead, interventions that address factors that proved to be relevant to sleep in our preliminary study have been integrated. We now want to test this manual for its effectiveness. Methods: A randomised controlled trial with N = 142 will be conducted to compare two conditions: the newly developed therapy manual will be carried out in the experimental group, while cognitive behavioural therapy for insomnia will be employed in the standard group. Both treatments will be conducted online via MS Teams in a group setting with seven sessions each. Data will be collected at three measurement points (pre, post, 6-month follow-up) and analysed using linear mixed models. The study will investigate whether the two treatments have led to significant improvements in total sleep time, sleep onset latency, subjective sleep quality and daytime sleepiness in shift workers. It will also examine whether the new therapy manual is superior to standard therapy in shift workers and whether these effects are stable. Discussion: We assume that interventions designed to address depressive mood, anxiety, worry, rumination, dysfunctional thought patterns and attitudes towards sleep will also improve sleep. If this is indeed the case, these interventions could replace previous ones that require regularity. This could significantly improve the treatment of insomnia in shift workers. Trial registration: German Clinical Trials Registry DRKS DRKS00032086. Registered on August 16, 2023. [ABSTRACT FROM AUTHOR]

Background: Racial disparities in sleep are well‐documented. However, evidence‐based options for addressing these disparities are lacking in cancer populations. To inform future research on sleep interventions, this study aims to understand racial differences in treatment responses to acupuncture and cognitive behavioral therapy for insomnia (CBT‐I) among Black and White cancer survivors. Methods: We conducted a secondary analysis of a comparative effectiveness trial evaluating acupuncture versus CBT‐I for insomnia in cancer survivors. We compared insomnia severity, sleep characteristics, and co‐morbid symptoms, as well as treatment attitudes, adherence, and responses among Black and White participants. Results: Among 156 cancer survivors (28% Black), Black survivors reported poorer sleep quality, longer sleep onset latency, and higher pain at baseline, compared to White survivors (all p < 0.05). Black survivors demonstrated lower adherence to CBT‐I than White survivors (61.5% vs. 88.5%, p = 0.006), but their treatment response to CBT‐I was similar to white survivors. Black survivors had similar adherence to acupuncture as white survivors (82.3% vs. 93.4%, p = 0.16), but they had greater reduction in insomnia severity with acupuncture (−3.0 points, 95% CI −5.4 to 0.4, p = 0.02). Conclusion: This study identified racial differences in sleep characteristics, as well as treatment adherence and responses to CBT‐I and acupuncture. To address racial disparities in sleep health, future research should focus on improving CBT‐I adherence and confirming the effectiveness of acupuncture in Black cancer survivors. [ABSTRACT FROM AUTHOR]

Summary Daridorexant is a dual orexin receptor antagonist for the treatment of insomnia. We report results from the first two randomised, double‐blind clinical studies of daridorexant in Japanese subjects. In the Phase 1 study, daridorexant (10, 25, 50 mg) or placebo were administered in the morning for 4 days in 24 young (mean age 26.9 years) and 24 older (mean age 69.7 years) healthy Japanese adults. Daridorexant reached a peak plasma concentration within 1.0 h across every dose and age group. For all doses, the mean plasma concentration of daridorexant showed a similar change between the age groups. Exposure parameters increased dose‐dependently with minimal/no accumulation upon repeated dosing. The terminal half‐life was ~8 h. In the Phase 2, four‐period, four‐way crossover study, 47 Japanese subjects (mean age 50.4 years) with insomnia disorder were randomised to receive four treatments (daridorexant 10, 25, 50 mg, placebo) during four treatment periods, each consisting of two treatment nights (5–12 day washout between treatment periods). Subjects continued their fourth treatment for 12 further days. A statistically significant dose–response relationship (multiple‐comparison procedure‐modelling, p < 0.0001) was found in the reduction of polysomnography‐measured wake after sleep onset (WASO; primary endpoint) and latency to persistent sleep (secondary endpoint) from baseline to days 1/2. Statistically significant dose–response relationships were also observed for secondary subjective endpoints from baseline to days 1/2 (sWASO, latency to sleep onset). All daridorexant doses were well tolerated, with no treatment discontinuations and no next‐morning residual effects. These results supported further investigation of daridorexant in Japanese patients with insomnia disorder. [ABSTRACT FROM AUTHOR]

Summary: Due to insufficient treatment options for insomnia, effective solutions are urgently needed. We evaluated the effects of a CBT‐I‐based app combining sleep training with subjective and objective sleep monitoring on (i) sleep and (ii) subjective‐objective sleep discrepancies (SOSD). Fifty‐seven volunteers (20–76 years; MAge = 45.67 ± 16.38; 39 female) suffering from sleep problems were randomly assigned to an experimental group (EG, n = 28) or a waitlist control group (CG, n = 29). During the 6‐week app phase, the EG used the CBT‐I‐based programme and a heart rate sensor for daily sleep monitoring and ‐feedback, while the CG used sleep monitoring only. Sleep was measured (i) subjectively via questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), (ii) objectively via ambulatory polysomnography (PSG), and (iii) continuously via heart‐rate sensor and sleep diaries. Data revealed interactions for ISI (p = 0.003, ƞ2part = 0.11) and PSQI (p = 0.050, ƞ2part = 0.05), indicating training‐specific improvements in EG, yet not in CG. While PSG‐derived outcomes appear to be less training‐specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p = 0.061, d = 0.55). Regarding changes in SOSD, the results indicate improvements during the app phase (EG) for sleep efficiency, sleep onset latency, and WASO (p ≤ 0.022, d ≥ 0.46); for total sleep time both groups showed a SOSD reduction. The findings indicate beneficial effects of a novel smartphone app on sleep and SOSD. More scientific evaluation of such digital programmes is needed to ultimately help in reducing the gap in non‐pharmacological insomnia treatment. [ABSTRACT FROM AUTHOR]

Summary: Several professional societies have provided recommendations for prescribing medications for insomnia. None has provided an integrative analysis that concurrently quantifies safety and efficacy (e.g., risk–benefit ratios). This represents an important gap for informing clinician decision‐making. Accordingly, the aim of the present review is to provide such an analysis for five classes of sleep‐promoting medications. Adverse event data values were extracted from the most recent FDA‐approved package inserts and converted to an integer before being placebo‐adjusted and standardized as a rate per 1000 (AEr). Efficacy data, pre‐to‐post self‐reported data for active and placebo conditions were acquired from pivotal trials identified in "white papers" and systematic reviews/meta‐analyses. Weighted effect sizes were calculated for subjective sleep latency, wake time after sleep onset and total sleep time, and then were averaged by medication class for each sleep continuity variable. Overall efficacy was represented by a single variable, SWT (sleep latency + wake time after sleep onset + total sleep time). Risk–benefit was represented using a simple ratio value. For safety, it was found that melatonin receptor agonists had the lowest adverse event rate (AEr = 43.1), and non‐benzodiazepine benzodiazepine receptor agonists had the highest rate (AEr = 255.0). For efficacy, it was found that the pre‐to‐post placebo adjusted effect sizes were largest for benzodiazepines (effect size = 1.94) and smallest for melatonin receptor agonists (effect size = 0.109). For risk–benefit, histamine antagonist had the most favourable profile (risk–benefit = 69.5), while melatonin receptor agonist had the least favourable profile (risk–benefit = 395.7). Overall, the combined metric for risk–benefit suggests that treatment with a histamine antagonist is optimal and potentially represents the best first‐line therapy for the medical management of insomnia. [ABSTRACT FROM AUTHOR]

Objective: Ziziphi Spinosae Semen oil (ZSSO) is a fatty oil extracted from Ziziphi Spinosae Semen, and its main component is unsaturated fatty acid. It is susceptible to oxidation and deterioration. The aim of this study was to improve the stability of ZSSO and protect its quality. Methods: gelatin-sodium alginate was used as the wall material for the preparation of ZSSO microcapsules by the complex coacervation. The particle size and zeta potential of the microcapsules were determined using a Malvern particle size meter. The microstructure and stability of the microcapsules were determined by SEM, FTIR, TGA and PV. The sleep-improving activity of the microcapsules was also determined by sleep induction assay, Elisa and HE staining. Results: The encapsulation efficiency of microcapsules was 56.08% ±0.19%, average particle size was 166.17 nm, and zeta potential was 38.2. Morphology of microcapsules was observed by SEM. The FTIR results showed that the fatty oil was successfully embedded, and PV indicated that microcapsules had a slow oxidation rate. A preliminary study on the sleep-improving activity of ZSSO and microcapsules demonstrated that it could shorten sleep latency and prolong sleep time of insomniac mice, and increase the levels of 5-HT and GABA and decrease the level of Glu in the brain of mice. In addition, ZSSO and microcapsules can repair damaged neuronal cells in the hypothalamus of insomniac mice to improve sleep. Conclusion: The quality evaluation of the microcapsules indicates that the prepared ZSSO-MPs have a small particle size and good stability. Moreover, ZSSO and microcapsules can effectively improve the sleep status of insomnia mice. [ABSTRACT FROM AUTHOR]

Among elderly persons insomnia has become a prevalent issue. It negatively affects their quality of life. Not only that it also exacerbates other medical disorders. The purpose of the research is to examine how yoga and Padabhyanga are effective in this case. It involved patients who are among the senior citizens or elderly categorised. It investigates the impact of yogic practices and Padabhyanga on the quality of sleep of insomnia sufferers. This study highlights the physiological and psychological mechanisms that underlines through some metrics. Metrics are like sleep latency, duration, and efficiency. It also holds the findings. Findings suggest yoga and Padabhyanga are very effective and holistic approaches. These holistic approaches can manage insomnia in the elderly persons. The study also highlights some limitations and future research. Through the future research this study could explore the long term benefits. [ABSTRACT FROM AUTHOR]

Background: Insomnia is common in adolescents. This study evaluated feasibility and preliminary efficacy of a six-week internet-delivered cognitive-behavioral therapy for insomnia (ICBT-I) in adolescents. Methods: In this uncontrolled pilot study, participants (n = 27, 78% female) completed assessments pre- and post intervention. Data on recruitment, adherence to treatment, treatment activity, satisfaction and credibility was collected to assess feasibility. Self-reported insomnia symptoms, sleep parameters as well as depression, anxiety and daytime function were also assessed. Results: Participants showed good adherence to treatment and found the intervention overall credible and satisfactory. From pre- to post-assessment, statistically significant improvements were found for insomnia symptoms (p <.001; d = 1.02), sleep onset latency (p <.001; d =.39), wake after sleep onset (p =.001; d =.34), sleep efficiency (p <.001; d =.5) and depression (p =.01, d =.37). Changes in scores of total sleep time, generalized anxiety, daytime sleepiness and functional disability were not significant. Conclusions: The present study indicates that ICBT-I is well accepted by adolescents, that insomnia symptoms and sleep parameters can improve following the intervention, and that co-morbid symptoms of depression can be reduced. Due to the limited sample size and the uncontrolled design, the suggested results need to be replicated in well-powered controlled clinical trials. [ABSTRACT FROM AUTHOR]

Sleep disturbances are an important symptom dimension of post-traumatic-stress-disorder (PTSD). There is no meta-analytic evidence examining the effects of all types of pharmacotherapy on sleep outcomes among patients with PTSD. Medline/Embase/PsychInfo/CENTRAL/clinicaltrials.gov/ICTRP, reference lists of published reviews and all included studies were searched for Randomised Controlled Trials (RCTs) examining any pharmacotherapy vs. placebo or any other drug among patients with PTSD. Primary outcomes: total sleep time, nightmares, sleep quality. Secondary outcomes: sleep onset latency, number of nocturnal awakenings, time spent awake following sleep onset, dropouts due to sleep-related adverse-effects, insomnia/somnolence/vivid-dreams as adverse-effects. Pairwise and network meta-analyses were performed. 99 RCTs with 10,481 participants were included. Prazosin may be the most effective treatment for insomnia (SMD = −0.88, 95%CI = [-1.22;-0.54], nightmares (SMD = −0.44, 95%CI = [-0.84;-0.04]) and poor sleep quality (SMD = −0.55, 95%CI = [-1.01;-0.10]). Evidence is scarce and indicates lack of efficacy for SSRIs, Mirtazapine, z-drugs and benzodiazepines, which are widely used in daily practice. Risperidone and Quetiapine carry a high risk of causing somnolence without having a clear therapeutic benefit. Hydroxyzine, Trazodone, Nabilone, Paroxetine and MDMA-assisted psychotherapy may be promising options, but more research is needed. Underpowered individual comparisons and very-low to moderate confidence in effect estimates hinder the generalisability of the results. More RCTs, specifically reporting on sleep-related outcomes, are urgently needed. • First network meta-analysis on all pharmacotherapy options for sleep disturbance in PTSD. • Prazosin may be effective in treating insomnia, nightmares and improving sleep quality. • Mirtazapine, benzodiazepines and z-drugs lack evidence and may be ineffective. • Risperidone and Quetiapine carry a high risk of somnolence and may be ineffective. • More research is strongly encouraged. [ABSTRACT FROM AUTHOR]

Objectives This study examined associations between various cognitive domains and sleep discrepancy (self-reported vs objectively measured sleep), and evaluated interactive associations with insomnia status (non-insomnia vs insomnia). Methods Older adults (N  = 65, M age = 68.72, SD  = 5.06, 43 insomnia/22 non-insomnia) aged 60+ reported subjective sleep (7 days of sleep diaries), objective sleep assessment (one-night polysomnography, PSG, via Sleep Profiler during the 7-day period), and completed cognitive tasks (National Institutes of Health Toolbox-Cognition Battery) measuring attention and processing speed, working memory, inhibitory control, cognitive flexibility, and episodic memory. The sleep diary variable corresponding to the same one night of PSG was used to calculate the sleep discrepancy (diary minus PSG parameter) variables for total sleep time (TST), sleep onset latency, wake after sleep onset, and sleep efficiency. Regression analyses determined independent and interactive (with insomnia status) associations between cognition and sleep discrepancy, controlling for age, sex, apnea–hypopnea index, and sleep medication usage. Results Working memory interacted with insomnia status in associations with sleep discrepancy related to TST and sleep efficiency. In those with insomnia, worse working memory was associated with shorter self-reported TST (p  = .008) and lower sleep efficiency (p  = .04) than PSG measured. Discussion In older adults with insomnia, worse working memory may be a contributing factor to sleep discrepancy. Future investigations of underlying neurophysiological factors and consideration of other objective sleep measures (actigraphy) are warranted. Prospective findings may help determine whether sleep discrepancy is a potential marker of future cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Natural products are widely used for primary insomnia (PI). This systematic review with trial sequential analysis (TSA) aimed to summarize evidence pertaining to the effectiveness and safety of Zao Ren An Shen (ZRAS) prescription, a commercial Chinese polyherbal preparation, for treating PI. Methods: Controlled clinical trials appraising ZRAS compared to controls or as an add-on treatment were systematically searched across seven databases until January 2024. Cochrane ROB 2.0 and ROBINS-I tools were adopted to determine risk of bias. Quality of evidence was assessed using the GRADE framework. Results: We analyzed 22 studies, involving 2,142 participants. The effect of ZRAS in reducing Pittsburgh Sleep Quality Index scores was found to be comparable to benzodiazepines [MD = 0.39, 95%CI (-0.12, 0.91), p = 0.13] and superior to Z-drugs [MD = -1.31, 95%CI (-2.37, -0.24), p = 0.02]. The addition of ZRAS to hypnotics more significantly reduced polysomnographically-recorded sleep onset latency [MD = -4.44 min, 95%CI (-7.98, -0.91), p = 0.01] and number of awakenings [MD = -0.89 times, 95%CI (-1.67, -0.10), p = 0.03], and increased total sleep time [MD = 40.72 min, 95%CI (25.14, 56.30), p < 0.01], with fewer adverse events than hypnotics alone. TSA validated the robustness of these quantitative synthesis results. However, the quality of evidence ranged from very low to low. The limited data available for follow-up did not support meta-synthesis. Conclusion: While ZRAS prescription shows promising effectiveness in treating PI, the overall quality of evidence is limited. Rigorously-designed randomized control trials are warranted to confirm the short-term efficacy of ZRAS and explore its medium-to-long-term efficacy. [ABSTRACT FROM AUTHOR]

Introduction: The online study investigated the sleep, psychological conditions, and risk factors during the wave of transmission of COVID-19 since December 7, 2022. Methods: We distributed questionnaires through networking mediums to residents to gather information about COVID-19 infection, sleep, and mental status. Results: During the extraordinary period in China, 91.9% of 1094 participants claimed to be infected with COVID-19, 36.8% reported poor sleep quality, 75.9% reported anxiety, and 65.5% reported depression. In retrospect, people have experienced lower sleep quality, longer sleep latency, enhanced rising time, and decreased sleep efficiency after the infection wave. After adjusting confounding factors, the elderly, women, urban residents, people with comorbidity, anxiety, depression, stress state, and COVID-19 infection have high risks for sleep disorders during the period. Discussion: The survey indicates that sleep disturbance caused by COVID-19 involves multiple dimensions, such as physiology, psychology, and society. The COVID-19 infection-related sleep problem should be taken seriously. Apart from conventional treatment, psychological issues of insomnia can not be ignored. [ABSTRACT FROM AUTHOR]

Objective: This narrative review aims to bridge the knowledge gap regarding the influence of exercise on sleep quality, exploring how various types, intensities, and timings of exercise impact sleep across different populations. Materials and Methods: A systematic search for relevant literature was conducted in scholarly databases such as Google Scholar, PubMed, MEDLINE, SPORTDiscus, CINAHL, and Web of Science. The search included terms related to physical activity and sleep, focusing on studies published in English from the past 10 years (2014-2024). Studies involving human participants and employing randomized controlled trials (RCTs) or observational study designs were prioritized. Results: Regular moderate-intensity aerobic exercise, such as brisk walking or cycling, significantly reduces sleep onset latency, improves sleep efficiency, and enhances subjective sleep quality across various populations. Potential mechanisms include stress hormone reduction, neurotransmitter regulation, and body temperature control. Emerging evidence suggests that resistance training can improve sleep onset latency and subjective sleep quality, particularly in older adults and individuals with chronic conditions. The benefits may be linked to muscle repair processes and stress reduction. The effects of High-Intensity Interval Training (HIIT) on sleep are mixed, with moderate-intensity programs showing potential benefits while excessive intensity or duration may disrupt sleep. Timing also plays a crucial role, with late-night HIIT potentially having negative impacts on sleep quality. Conclusion: Regular exercise, especially moderate-intensity aerobic exercise, is a powerful tool for improving sleep quality. Resistance training also holds promise, particularly for specific populations. The impact of HIIT on sleep requires further research to determine optimal training parameters. Healthcare professionals should guide patients in tailoring exercise programs to optimize sleep benefits. [ABSTRACT FROM AUTHOR]

Objective: The study retrospectively evaluated the effects of quetiapine on sleep in primary insomnia and neurodegenerative diseases using polysomnographic data. Materials and Methods: Between January 1, 2010, and June 1, 2023, the records of 49 patients who were followed up in the sleep outpatient clinic of the neurology department of our hospital and who underwent polysomnography examination were retrospectively reviewed. Patients aged between 18 and 65 years with primary insomnia and neurodegenerative diseases were included in the study. Results: The mean age of 49 patients (26 females and 23 males) were 56.67 years. The mean quetiapine dose was 59.37. Sleep latency, stage 1 (N1) duration, stage 2 (N2) duration, mean and minimum SO2 and apnea-hypopnea index were similar. Total sleep duration, stage 3 (N3) duration and rapid eye movement (REM) sleep duration were higher in neurodegenerative patients. N3 duration was shorter in patients with primary insomnia on quetiapine. Sleep duration and REM duration were longer in the neurodegenerative group and sleep latency was longer in primary insomnia in quetiapine users. Among quetiapine users, the N2 sleep percentage was higher and the nonREM 3 sleep percentage was lower in primary insomnia, whereas there was no difference in sleep percentages in neurodegenerative patients. Conclusion: Quetiapine is an atypical antipsychotic agent. It shortens sleep latency and decreases the percentage of REM sleep and wake time. It increases total sleep time, sleep efficiency, and N2 sleep. In this study, in primary insomnia patients using quetiapine, N3 sleep duration was shorter and sleep percentage was lower, whereas N2 sleep percentage was longer. There has been no placebo-controlled study of any antipsychotic drug for treating insomnia. [ABSTRACT FROM AUTHOR]

This article, published in the journal Cell Discovery, explores the role of leptin receptor neurons in the ventral premammillary nucleus (PMv) in modulating emotion-induced insomnia. The study found that exposure to emotional stimuli, such as urine or TMT (a component of fox odor), significantly delayed non-rapid eye movement (NREM) sleep onset and increased wakefulness in mice. The researchers also discovered that PMvLepR neurons were activated by emotional stimuli and that their activation led to prolonged wakefulness, mimicking insomnia-like behavior. Inhibition of PMvLepR neurons abolished the increase in sleep latency and wakefulness following emotional stimuli. These findings suggest that PMvLepR neurons may be an important therapeutic target for managing emotion-induced insomnia. [Extracted from the article]

Background: COMISA is a common disorder that results in nighttime awakenings ,daytime sleepiness and PAP intolerance. Cognitive behavioral therapy for insomnia is used to improve PAP adherence and no medication has been evaluated in such population yet. Melatonin with its chronobiotic and antioxidant effects may have potential benefits on COMISA consequences at the appropriate dose and time. This study aimed to evaluate the effect of melatonin on sleep quality, daytime sleepiness and PAP Compliance in patients with COMISA. Methods: This double-blind placebo trial randomly assigned eligible OSA patients who suffered from insomnia despite using PAP for over a month to receive either melatonin 10 mg or placebo. The primary outcomes were measured by changes in the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ-10) over one month. Adherence to PAP was measured by the results of the PAP device reports on the average length of time and number of nights that the device was used. Results: Thirty patients were enrolled in the study after randomization. The melatonin arm showed significant improvement in all four primary outcomes compared to the placebo arm. The PSQI score was 3.836±1.839 in the melatonin arm versus 10.522±3.626 in the placebo arm (Pvalue<0.001). The ISI score was 8.476±3.568 in the melatonin arm versus 14.47±4.50 in the placebo arm (Pvalue<0.001). The ESS score was 6.854±4.334 in the melatonin arm versus 13.298±5.119 in the placebo arm (Pvalue<0.001). The FOSQ-10 score was 24.93±5.02 in the melatonin arm versus 19.87±4.24 in the placebo arm (Pvalue= 0.006). Additionally, nighttime consequences such as sleep latency and awakenings showed significant improvement in the melatonin arm. PAP devices results revealed improvement in duration of PAP use overnight. Conclusions: Administering melatonin has been shown to improve self-reported sleep quality and PAP adherence in patients with COMISA. Trial registration: Registration number IRCT20220105053635N1 was issued by the Iranian Registry of Clinical Trials (IRCT). [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) and sleep disturbance are highly comorbid and repetitive negative thinking (RNT) is associated with both sleep disturbance and PTSD. However, few studies have examined the association between RNT and sleep disturbance in individuals exposed to trauma, with and without PTSD. Associations between trait-level and trauma-related RNT, insomnia, and sleep quality were investigated in a trauma-exposed MTurk (N = 342) sample. Additionally, PTSD symptom severity was tested as a moderator of the associations between RNT and insomnia and sleep quality. Trait-level RNT predicted poorer sleep quality and greater insomnia, regardless of PTSD severity. Trauma-related RNT was also associated with greater insomnia, though the effect was moderated by PTSD severity such that it was significant for participants with low and moderate, but not severe, PTSD. Both trait- and trauma-related RNT were associated with several specific aspects of sleep quality, including: sleep disturbances, daytime dysfunction, use of sleep medications, sleep onset latency, and subjective sleep quality. This study demonstrates significant associations linking RNT with insomnia and sleep disturbance in trauma-exposed individuals. Clinically, results suggest that it may be helpful to target both general and trauma-related RNT in sleep interventions for trauma-exposed individuals with insomnia. [ABSTRACT FROM AUTHOR]

Cannabis sativa has been used for improving sleep for long history. Cannabidiol (CBD) has drown much attention as a non-addictive psychoactive component in Cannabis sativa extract. However, the effects of CBD on sleep architecture and it's acting mechanism remains unclear. In the present study, we evaluated the sedative-hypnotic effect of cannabidiol (CBD), assessed the effects of CBD on sleep using a wireless physiological telemetry system. We further explored the therapeutic effects of CBD using 4-chloro-dl-phenylalanine (PCPA) induced insomnia model and changes in sleep latency, sleep duration and intestinal flora were evaluated. CBD shortened sleep latency and increases sleep duration in both normal and insomnia mice, and those effects were blocked by 5-HT1A receptor antagonist WAY100635. We determined that CBD increases 5-HT1A receptors expression and 5-HT content in the hypothalamus of PCPA-pretreated mice and affects tryptophan metabolism in the intestinal flora. These results showed that activation of 5-HT1A receptors is one of the potential mechanisms underlying the sedative-hypnotic effect of CBD. This study validated the effects of CBD on sleep and evaluated its potential therapeutic effects on insomnia. [ABSTRACT FROM AUTHOR]

To explore sleep structure in participants with obstructive sleep apnea (OSA) and comorbid insomnia (COMISA) and participants with OSA without insomnia (OSA-only) using both single-night polysomnography and multi-night wrist-worn photoplethysmography/accelerometry. Multi-night 4-class sleep-staging was performed with a validated algorithm based on actigraphy and heart rate variability, in 67 COMISA (23 women, median age: 51 years) and 50 OSA-only (15 women, median age: 51) participants. Sleep statistics were compared using linear regression models and mixed-effects models. Multi-night variability was explored using a clustering approach and between- and within-participant analysis. Polysomnographic parameters showed no significant group differences. Multi-night measurements, during 13.4 ± 5.2 nights per subject, demonstrated a longer sleep onset latency and lower sleep efficiency for the COMISA group. Detailed analysis of wake parameters revealed longer mean durations of awakenings in COMISA, as well as higher numbers of awakenings lasting 5 min and longer (WKN ≥5min) and longer wake after sleep onset containing only awakenings of 5 min or longer. Within-participant variance was significantly larger in COMISA for sleep onset latency, sleep efficiency, mean duration of awakenings and WKN ≥5min. Unsupervised clustering uncovered three clusters; participants with consistently high values for at least one of the wake parameters, participants with consistently low values, and participants displaying higher variability. Patients with COMISA more often showed extended, and more variable periods of wakefulness. These observations were not discernible using single night polysomnography, highlighting the relevance of multi-night measurements to assess characteristics indicative for insomnia. • Single-night sleep measurements show limited value in the differentiation between OSA and COMISA. • COMISA patients more often show extended periods of wakefulness over multiple nights. • Combined photoplethysmography and actigraphy can adequately capture these differences. • Multi-night assessment is useful to objectively identify comorbid insomnia and prompt further investigation. [ABSTRACT FROM AUTHOR]

Background: Patients with migraine often have poor sleep quality between and during migraine attacks. Furthermore, extensive research has identified photophobia as the most common and most bothersome symptom in individuals with migraine, second only to headache. Seeking the comfort of darkness is a common strategy for managing pain during an attack and preventing its recurrence between episodes. Given the well-established effects of daily light exposure on circadian activity rhythms and sleep quality, this study aimed to investigate the relationship between photophobia symptoms and sleep quality in a cohort of patients with migraine. Methods: A cross-sectional observational study was conducted using existing data extracted from the American Registry for Migraine Research (ARMR). Participants with a migraine diagnosis who had completed the baseline questionnaires (Photosensitivity Assessment Questionnaire (PAQ), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2)), and selected questions of the ARMR Sleep questionnaire were included. Models were created to describe the relationship of photophobia and photophilia with various sleep facets, including sleep quality (SQ), sleep disturbance (SDis), sleep onset latency (SOL), sleep-related impairments (SRI), and insomnia. Each model was controlled for age, sex, headache frequency, anxiety, and depression. Results: A total of 852 patients meeting the inclusion criteria were included in the analysis (mean age (SD) = 49.8 (13.9), 86.6% (n = 738) female). Those with photophobia exhibited significantly poorer sleep quality compared to patients without photophobia (p < 0.001). Photophobia scores were associated with SQ (p < 0.001), SDis (p < 0.001), SOL (p = 0.011), SRI (p = 0.020), and insomnia (p = 0.005) after controlling for age, sex, headache frequency, depression, and anxiety, signifying that higher levels of photophobia were associated with worse sleep-related outcomes. Conversely, photophilia scores were associated with better sleep-related outcomes for SQ (p < 0.007), SOL (p = 0.010), and insomnia (p = 0.014). Conclusion: Results suggest that photophobia is a significant predictor of poor sleep quality and sleep disturbances in migraine. These results underscore the necessity for comprehensive and systematic investigations into the intricate interplay between photophobia and sleep to enhance our understanding and develop tailored solutions for individuals with migraine. [ABSTRACT FROM AUTHOR]

Objective: This pilot study assessed the effects of electronic noise-masking earbuds on subjective sleep perception and objective sleep parameters among healthcare workers (HCWs) reporting sleep difficulties during the COVID-19 pandemic. Methods: Using a pre-post design, 77 HCWs underwent 3 nights of baseline assessment followed by a 7-night intervention period. Participants wore an at-home sleep monitoring headband to assess objective sleep measures and completed subjective self-report assessments. The difference in mean sleep measures from baseline to intervention was estimated in linear mixed models. Results: Compared to baseline assessments, HCWs reported significant improvements in sleep quality as measured by the Insomnia Severity Index (ISI) (Cohen's d = 1.74, p < 0.001) and a significant reduction in perceived sleep onset latency (SOL) during the intervention (M = 17.2 minutes, SD = 7.7) compared to baseline (M = 24.7 minutes, SD = 16.1), (Cohen's d = -0.42, p = 0.001). There were no significant changes in objective SOL (p = 0.703). However, there was a significant interaction between baseline objective SOL (<20 minutes vs >20 minutes) and condition (baseline vs intervention) (p = 0.002), such that individuals with objective SOL >20 minutes experienced a significant decrease in objective SOL during the intervention period compared to baseline (p = 0.015). Conclusions: HCWs experienced a significant improvement in perceived SOL and ISI scores after using the electronic noise-masking earbuds. Our data provide preliminary evidence for a nonpharmacological intervention to improve the sleep quality of HCWs which should be confirmed by future controlled studies. [ABSTRACT FROM AUTHOR]

The article discusses the assessment and treatment of insomnia in older adults. Topics covered include the pathway of obtaining a thorough sleep history, assessing environmental factors, evaluating behavioral and social factors, assessing comorbid medical substance use disorders, evaluating medication effects on sleep, reviewing sleep diaries and sleep-insomnia indexes, and diagnosing insomnia. Also noted are the insomnia approved medications, and nonpharmacological treatments for insomnia.

Summary: Two out of three adults seeking treatment for alcohol or other substance use disorders report co‐occurring symptoms of insomnia. This study compared the feasibility, acceptability, and preliminary efficacy of cognitive behavioural therapy for insomnia (CBT‐I) among adults seeking and not seeking treatment for substance use. Adults with alcohol or other substance use disorders (n = 22, 32% female, 82% White; Mage = 39.5) completed assessments at baseline, post‐treatment, and at 6 week follow‐up. Of those, 11 were and 11 were not enrolled in substance use treatment. All received CBT‐I. Multiple imputation was used for missing data. Data were analysed using repeated measures analyses of variance. In the substance use treatment group, 6/11 completed post and 5/11 completed follow‐up. In the non‐treatment group, 9/11 completed post and 7/11 completed follow‐up. Participants in both groups reported improvements in insomnia severity, sleep onset latency, and dysfunctional beliefs about sleep, with most effects evident at post and follow‐up. There was a marginal group‐by‐time interaction in the change in frequency of substance use, with only participants not in substance use treatment reporting decreases at follow‐up. Participants in substance use treatment reported significant reductions in substance‐related problems and symptoms of post‐traumatic stress disorder over time; however, they also reported more symptoms at baseline. CBT‐I produces similar reductions in insomnia but is relatively less feasible among individuals in (versus not in) treatment for substance use disorder. This may be due to the more complex logistics of accessing CBT‐I among those in treatment. We speculate that integrating CBT‐I into treatment for addictions may improve feasibility in this population. clinicaltrials.gov NCT04198311. [ABSTRACT FROM AUTHOR]

Key Points: Question: What is the association of each component and delivery format of cognitive behavioral therapy for chronic insomnia with outcomes? Findings: This systematic review and component network meta-analysis including 241 trials found that cognitive restructuring, third-wave components, sleep restriction, stimulus control, and in-person format may be beneficial. Cognitive restructuring, third-wave components and in-person delivery were mainly associated with improved subjective sleep quality, while sleep restriction and stimulus control were associated both with improved sleep quality and self-reported sleep continuity. Meaning: The findings suggest that beneficial cognitive behavioral therapy for insomnia may include cognitive restructuring, third-wave components, sleep restriction, stimulus control, and in-person format. This systematic review and component network meta-analysis evaluates associations between different components and delivery formats of cognitive behavior therapy for insomnia. Importance: Chronic insomnia disorder is highly prevalent, disabling, and costly. Cognitive behavioral therapy for insomnia (CBT-I), comprising various educational, cognitive, and behavioral strategies delivered in various formats, is the recommended first-line treatment, but the effect of each component and delivery method remains unclear. Objective: To examine the association of each component and delivery format of CBT-I with outcomes. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, PsycInfo, and International Clinical Trials Registry Platform from database inception to July 21, 2023. Study Selection: Published randomized clinical trials comparing any form of CBT-I against another or a control condition for chronic insomnia disorder in adults aged 18 years and older. Insomnia both with and without comorbidities was included. Concomitant treatments were allowed if equally distributed among arms. Data Extraction and Synthesis: Two independent reviewers identified components, extracted data, and assessed trial quality. Random-effects component network meta-analyses were performed. Main Outcomes and Measures: The primary outcome was treatment efficacy (remission defined as reaching a satisfactory state) posttreatment. Secondary outcomes included all-cause dropout, self-reported sleep continuity, and long-term remission. Results: A total of 241 trials were identified including 31 452 participants (mean [SD] age, 45.4 [16.6] years; 21 048 of 31 452 [67%] women). Results suggested that critical components of CBT-I are cognitive restructuring (remission incremental odds ratio [iOR], 1.68; 95% CI, 1.28-2.20) third-wave components (iOR, 1.49; 95% CI, 1.10-2.03), sleep restriction (iOR, 1.49; 95% CI, 1.04-2.13), and stimulus control (iOR, 1.43; 95% CI, 1.00-2.05). Sleep hygiene education was not essential (iOR, 1.01; 95% CI, 0.77-1.32), and relaxation procedures were found to be potentially counterproductive(iOR, 0.81; 95% CI, 0.64-1.02). In-person therapist-led programs were most beneficial (iOR, 1.83; 95% CI, 1.19-2.81). Cognitive restructuring, third-wave components, and in-person delivery were mainly associated with improved subjective sleep quality. Sleep restriction was associated with improved subjective sleep quality, sleep efficiency, and wake after sleep onset, and stimulus control with improved subjective sleep quality, sleep efficiency, and sleep latency. The most efficacious combination—consisting of cognitive restructuring, third wave, sleep restriction, and stimulus control in the in-person format—compared with in-person psychoeducation, was associated with an increase in the remission rate by a risk difference of 0.33 (95% CI, 0.23-0.43) and a number needed to treat of 3.0 (95% CI, 2.3-4.3), given the median observed control event rate of 0.14. Conclusions and Relevance: The findings suggest that beneficial CBT-I packages may include cognitive restructuring, third-wave components, sleep restriction, stimulus control, and in-person delivery but not relaxation. However, potential undetected interactions could undermine the conclusions. Further large-scale, well-designed trials are warranted to confirm the contribution of different treatment components in CBT-I. [ABSTRACT FROM AUTHOR]

Introduction: Recent research highlights the significance of insomnia and sleepiness, shifting from obstructive sleep apnea (OSA) severity and sleep structure, in defining OSA phenotypes.Objectives: This study aimed to characterize insomnia and sleepiness associated with OSA phenotypes and assess their involvement in depression symptoms (DS) in OSA.Materials and methods: This cross-sectional, clinical study included 181 participants who underwent polysomnography (PSG) and filled out questionnaires, including the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Index (BDI). They were categorized into phenotypes: insomnia–sleepiness (I + S; ESS ≥ 11; ISI ≥ 15; n = 20), sleepiness (S; ESS ≥ 11; ISI < 15; n = 22), insomnia (I; ESS < 11; ISI ≥ 15), and asymptomatic (A; ESS < 11; ISI<15; n=55).Results: A linear regression model for the BDI score (R² = 0.357, p < 0.001) included ISI score and subjective-to-objective sleep latency ratio. The ISI score was a predictive factor for mild and moderate DS [OR = 1.23 (95% CI: 1.09–1.38), p < 0.001 and OR = 1.39 (95% CI: 1.13–1.72), p = 0.002]. The I and I + S phenotypes are characterized by higher BDI scores (p < 0.001 and p = 0.02), longer subjective sleep latency (p = 0.008 and p = 0.04), and shorter subjective total sleep time (TST; p = 0.049 and p = 0.006) compared to A. Furthermore, the I and I + S groups had shorter subjective TST than S (p = 0.03 and p = 0.047). The I and I + S had higher BDI scores than A (p < 0.001 and p = 0.02, respectively) and S (p < 0.001 and p = 0.02, respectively). The I phenotype was associated with the risk of mild and moderate DS (OR = 5.61 (95% CI: 1.91–16.53), p < 0.001 and OR = 9.55 (95% CI: 1.81–50.48), p = 0.008 respectively). Moreover, the I + S phenotype presented an even greater risk for mild DS (OR = 10.29 (95% CI: 2.95–35.85), p < 0.001).Conclusion: Using clinical features for OSA phenotyping holds promise for finding OSA individuals with increased risk for DS occurrence. [ABSTRACT FROM AUTHOR]

To provide a comprehensive assessment of sleep state misperception in insomnia disorder (INS) and good sleepers (GS) by comparing recordings performed for one night in-lab (PSG and night review) and during several nights at-home (actigraphy and sleep diaries). Fifty-seven INS and 29 GS wore an actigraphy device and filled a sleep diary for two weeks at-home. They subsequently completed a PSG recording and filled a night review in-lab. Sleep perception index (subjective/objective × 100) of sleep onset latency (SOL), sleep duration (TST) and wake duration (TST) were computed and compared between methods and groups. GS displayed a tendency to overestimate TST and WASO but correctly perceived SOL. The degree of misperception was similar across methods within the GS group. In contrast, INS underestimated their TST and overestimated their SOL both in-lab and at-home, yet the severity of misperception of SOL was larger at-home than in-lab. Finally, INS overestimated WASO only in-lab while correctly perceiving it at-home. While only the degree of TST misperception was stable across methods in INS, misperception of SOL and WASO were dependent on the method used. We found that GS and INS exhibit opposite patterns and severity of sleep misperception. While the degree of misperception in GS was similar across methods, only sleep duration misperception was reliably detected by both in-lab and at-home methods in INS. Our results highlight that, when assessing sleep misperception in insomnia disorder, the environment and method of data collection should be carefully considered. • Good sleepers and participants with insomnia exhibit opposite patterns and severity of sleep misperception. • Only sleep duration misperception was reliably detected by both in-lab and at-home methods in insomnia and good sleepers. • In insomnia disorder, sleep latency and wake duration misperception are different depending on the methods used. • Methodology and environment depending on the population should be considered when assessing sleep misperception. [ABSTRACT FROM AUTHOR]

To summarize the evidence of various exercise modalities on population with insomnia disorders. PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies published from inception to October 2022 and updated on September 2023. Systematic reviews with meta-analyses and randomized controlled trials designed to investigate the effect of various exercise modalities on population with insomnia were eligible. A total of 4 SRs with (very) low methodological quality and 1034 participants in 10 network meta-analyses explored the association between different types and intensity exercise modalities with insomnia disorders. Various exercise modalities could significantly improve total sleep time and sleep quality and alleviate insomnia severity. Compared to passive control, moderate aerobic exercise, moderate aerobic exercise combined with light intensity strength and mind-body exercise can improve sleep efficiency and reduce wake after sleep onset by objectively measured. Moderate intensity strength, light intensity strength and mind-body exercise can improve sleep efficiency subjectively measured; mind-body exercise can reduce sleep onset latency and wake time after sleep onset, and increase total sleep time; moderate aerobic exercise can reduce sleep onset latency. Moderate intensity strength, light intensity strength, mind body exercise and moderate aerobic exercise combined with light intensity strength can the severity of insomnia and improv sleep quality. Exercise had a positive effect on relief insomnia and improve sleep quality. Moderate aerobic exercise, mind-body exercise and moderate aerobic exercise combined with light intensity strength play an important role in improving the sleep quality in people with insomnia disorders. • Exercise has a positive effect on relieving the insomnia disorders. • Effect of various intensities, types of exercise in improving insomnia are different. • Exercise can alleviate the severity of insomnia and improve sleep quality. • The evidence on the effect of exercise on insomnia is low in quantity and quality. • In the future, more high-quality studies are needed. [ABSTRACT FROM AUTHOR]

Objective: Cannabidiol (CBD) is a non-intoxicating extract from Cannabis sativa. The advantages of CBD on sleep-wake cycle and insomnia remain sparse. The present study investigated the impact of a continuous four-week sublingual CBD intake on sleep indicators. Materials and Methods: The present study was a randomized, double-blind, placebo-controlled, crossover pilot study involving 45 chronic insomnia patients. The participants were administered medium-chain triglycerides oil soluble cannabidiol (MCT-CBD) using 1 mg/kg/dose, sublingually for four weeks, then two weeks of washout period, and a subsequent four-week placebo phase. Sleep architecture with N1, N2, N3, and rapid eye movement (REM), sleep quality (PSQI), daytime sleepiness (ESS), and quality of life were investigated. Results: Polysomnography (PSG) revealed that the total sleep time (TST), sleep onset latency (SOL), wake time after sleep onset (WASO), and arousal index were significantly improved compared to the patients who were taking placebo, while sleep structure remained unaltered. Additionally, actigraphy showed a substantial improvement in TST, sleep efficiency (SE), and SOL. The results of PSQI, ESS, and EQ-5D-5L were statistically significant and better than placebo (p<0.05). Conclusion: Continuously sublingual CBD treatment could improve sleep duration, sleep maintenance, sleep induction, quality of life, and daytime sleepiness without altering the sleep architecture in patients with chronic insomnia. No evidence of serious side-effects was found. [ABSTRACT FROM AUTHOR]

To identify and critically evaluate models predicting insomnia treatment response in adult populations. Pubmed, EMBASE, and PsychInfo databases were searched from January 2000 to January 2023 to identify studies reporting the development or validation of multivariable models predicting insomnia treatment outcomes in adults. Data were extracted according to CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) guidelines and study quality was assessed using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). Eleven studies describing 53 prediction models were included and appraised. Treatment response was most frequently assessed using wake after sleep onset (n = 10; 18.9%), insomnia severity index (n = 10; 18.9%), and sleep onset latency (n = 9, 17%). Dysfunctional Beliefs About Sleep (DBAS) score was the most common predictor in final models (n = 33). R2 values ranged from 0.06 to 0.80 for models predicting continuous response and area under the curve (AUC) ranged from 0.73 to 0.87 for classification models. Only two models were internally validated, and none were externally validated. All models were rated as having a high risk of bias according to PROBAST, which was largely driven by the analysis domain. Prediction models may be a useful tool to assist clinicians in selecting the optimal treatment strategy for patients with insomnia. However, no externally validated models currently exist. These results highlight an important gap in the literature and underscore the need for the development and validation of modern, methodologically rigorous models. [ABSTRACT FROM AUTHOR]

Discrepancies between sleep diaries and actigraphy occur among individuals with insomnia. Cognitive behavioural therapy for insomnia (CBT-I) improves insomnia but the impact on discrepancy is unclear. This study examined CBT-I's effects on actigraphy-diary discrepancy and explored sleep-related beliefs and attitudes as a mediator. Participants were 108 (age M ± SD = 47.23 ± 12.42, 67.60 % female) adults with insomnia and major depressive disorder from the Treatment of Insomnia and Depression study. They were randomized to 7 sessions of CBT-I or sham Quasi-Desensitization Therapy for Insomnia (DTI), plus 16 weeks of antidepressants. Two weeks of actigraphy and sleep diary were collected at baseline, mid-treatment, end-treatment. Differences between sleep diary and actigraphy total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated. Participants completed Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) at baseline and mid-treatment. At baseline, diary (versus actigraphy) TST was shorter (1.1 ± 1.41h), whilst SOL (21.64 ± 41.25min) and WASO (17.45 ± 61.99min) were longer. Mixed effects models using daily data showed that after adjusting for age and sex, participants in the CBT-I group (versus DTI) showed greater reduction in all actigraphy-diary discrepancy domains (all p-values <.01), reductions evident from mid-treatment. Group differences on actigraphy-diary discrepancy reductions in TST, SOL, and SE (not WASO) were mediated by changes in DBAS from baseline to mid-treatment (all p-values <.05). Changes in discrepancy did not mediate insomnia symptom changes (p-values >.39). CBT-I reduced actigraphy-diary discrepancy in individuals with comorbid insomnia and depression; this reduction was associated with improved sleep-related attitudes, a therapeutic target of CBT-I. TRIAD (Treatment of Insomnia and Depression): Improving Depression Outcome by Adding Insomnia Therapy to Antidepressants. Prospectively registered with Clinical Trials (NCT00767624). MH078924, MH078961, MH079256. • Individuals with insomnia and depression reported shorter and worse sleep compared to actigraphy measures. • CBT-I reduced actigraphy-diary discrepancy in these individuals. • Discrepancy reduction was associated with improved sleep-related attitudes and beliefs. [ABSTRACT FROM AUTHOR]

Summary: Stimulus control (SC) is commonly viewed as an evidence‐based treatment for insomnia, but it has not been evaluated comprehensively with modern review and meta‐analytic techniques. The aim of the current study was thus to perform a systematic review and meta‐analysis of trials that examine the efficacy of stimulus control for insomnia. A systematic search for eligible articles and dissertations was conducted in six online bibliographic databases. The 11 included studies, with the majority published between 1978 and 1998, were randomised controlled and experimental studies in adults, comparing stimulus control for insomnia with passive and active comparators and assessing insomnia symptoms as outcomes. A random effects model was used to determine the standardised mean difference Hedge's g at post‐treatment and follow‐up for three sleep diary measures: the number of awakenings, sleep onset latency, and total sleep time. A test for heterogeneity was conducted, forest plots were produced, the risk of publication bias was estimated, and the study quality was assessed. In the trials identified, stimulus control resulted in small to large improvements on sleep onset latency and total sleep time, relative to passive comparators (g = 0.38–0.85). Compared with active comparators, the improvements following stimulus control were negligible (g = 0.06–0.30). Although methodological uncertainties were observed in the included trials, stimulus control appears to be an efficacious treatment for insomnia when compared with passive comparators and with similar effects to active comparators. More robust studies are, however, warranted before stronger conclusions are possible to infer. [ABSTRACT FROM AUTHOR]