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While evidence supports the benefits of medications for the treatment of chronic insomnia, there is ongoing debate regarding their appropriate duration of use. A panel of sleep experts conducted a clinical appraisal regarding the use of insomnia medications, as it relates to the evidence supporting the focus statement, "No insomnia medication should be used on a daily basis for durations longer than 3 weeks at a time". The panelists' assessment was also compared to findings from a national survey of practicing physicians, psychiatrists, and sleep specialists. Survey respondents revealed a wide range of opinions regarding the appropriateness of using the US Food and Drug Administration (FDA)-approved medications for the treatment of insomnia lasting more than 3 weeks. After discussion of the literature, the panel unanimously agreed that some classes of insomnia medications, such as non-benzodiazepines hypnotics, have been shown to be effective and safe for long-term use in the appropriate clinical setting. For eszopiclone, doxepin, ramelteon and the newer class of dual orexin receptor antagonists, the FDA label does not specify that their use should be of a limited duration. Thus, an evaluation of evidence supporting the long-term safety and efficacy of newer non-benzodiazepine hypnotics is timely and should be considered in practice recommendations for the duration of pharmacologic treatment of chronic insomnia.

While both patients and physicians consider sleep to be important, sleep health may not receive appropriate consideration during patient visits with health care professionals (HCPs). We completed the first large-scale survey of people with trouble sleeping (PWTS) and physicians who treat insomnia to understand their perspectives and potential discrepancies between them. The Harris Poll conducted online surveys of adult PWTS and HCPs (primary care physicians [PCPs] and psychiatrists) in the United States from September to October 2021. Respondents included 1001 PWTS, 300 PCPs, and 152 psychiatrists. Most HCPs agreed that sleep is critical to good health, yet very few reported routinely conducting full sleep histories on their patients. Approximately 30% of PWTS reported that their PCP never asks about sleep; zero HCPs in this survey reported "never" inquiring. Few HCPs reported being "very satisfied" with current treatment options; 50% of PCPs reported their patients being satisfied. Two-thirds of PWTS did not believe current treatment options adequately improved their sleep. This survey provides evidence that both PWTS and physicians agreed on the importance of sleep, but that treatment is often perceived as ineffective. This survey identifies a need for HCPs to address insomnia management and treatment gaps.

A scientific advisory panel of seven U.S. and Canadian sleep experts performed a clinical appraisal by comparing general medical opinion, assessed via a survey of practicing clinicians, regarding insomnia treatment, with the available scientific evidence. This clinical appraisal focuses on the specific statement, "Treatments for insomnia have uniformly been shown to significantly improve the associated daytime impairment seen with insomnia." The advisory panel reviewed and discussed the available body of evidence within the published medical literature to determine what discrepancies may exist between the currently published evidence base and general medical opinion. The advisory panels' evaluation of this statement was also compared with the results of a national survey of primary care physicians, psychiatrists, nurse practitioners, physician assistants, and sleep specialists in the United States. Contrary to general medical opinion, the expert advisory panel concluded that the medical literature did not support the statement. This gap highlights the need to educate the general medical community regarding insomnia treatment efficacy in pursuit of improved treatment outcomes.

Trazodone is one of the most commonly used prescription medications for insomnia; however, some recent clinical guidelines do not recommend its use for treating insomnia. This clinical appraisal critically reviews the scientific literature on trazodone as a first-line treatment for insomnia, with the focus statement "Trazodone should never be used as a first-line medication for insomnia." In addition, field surveys were sent to practicing physicians, psychiatrists, and sleep specialists to assess general support for this statement. Subsequently, a meeting with a seven-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This paper reports on the evidence review, the panel discussion, and the panel's and healthcare professionals' ratings of the statement's acceptability. While the majority of field survey responders disagreed with the statement, the majority of panel members agreed with the statement based on the limited published evidence supporting trazodone as a first-line agent as they understood the term "first-line agent".

Insomnia is a significant, highly prevalent, persistent public health problem but often remains undiagnosed and untreated. Current treatment practices are not always evidence-based. When insomnia is comorbid with anxiety or depression, treatment often targets that comorbid condition with the expectation that improvement of the mental health condition will generalize to sleep symptoms. An expert panel of seven members conducted a clinical appraisal of the literature regarding the treatment of insomnia when comorbid anxiety or depression are also present. The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the panel's predetermined clinical focus statement, "Whenever chronic insomnia is associated with another condition, such as anxiety or depression, that psychiatric condition should be the only focus of treatment as the insomnia is most likely a symptom of the condition". The results from an electronic national survey of US-based practicing physicians, psychiatrists, and sleep (N = 508) revealed that >40% of physicians agree "at least somewhat" that treatment of comorbid insomnia should focus solely on the psychiatric condition. Whereas 100% of the expert panel disagreed with the statement. Thus, an important gap exists between current clinical practices and evidence-based guidelines and more awareness is needed so that insomnia is treated distinctly from comorbid anxiety and depression.

INTRODUCTION: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. METHODS: The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. RESULTS: The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations.

ObjectiveTo determine whether high school start time is associated with headache frequency in adolescents with migraine.BackgroundAdolescence is marked by a physiologic delayed circadian phase, characterized by later bedtimes and wake times. The American Academy of Pediatrics (AAP) recommends that high schools start no earlier than 8:30 a.m., but most high schools in the United States start earlier. The study hypothesis was that adolescents with migraine whose high schools start at 8:30 a.m. or later (late group) would have lower headache frequency than those whose schools start earlier than 8:30 a.m. (early group).MethodsThis was a cross-sectional Internet survey study of US high schoolers with migraine recruited online through social media. Comparisons were made between the late group and the early group. The primary outcome measure was self-reported headache days/month.ResultsIn total, 1012 respondents constituted the analytic set: n = 503 in the late group versus n = 509 in the early group. Mean (SD) self-reported headache days/month was 4.8 (4.6) versus 7.7 (6.1) in the late and early groups, respectively (p

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine, in a 3-4-year recurring cycle of topics. These topics will be presented at the 2020 Virtual Conference. Below is the adult sleep medicine core that includes topics pertinent to sleep-disordered breathing and insomnia.

Introduction: Social workers, the largest group of mental health clinicians in the United States, play a pivotal role in mental health promotion. Despite the importance of sleep for mental health, there is no empirical research on sleep education interventions for social workers. Method: We designed an online sleep health education intervention to equip social work students to promote healthy sleep practices among their clients. An interdisciplinary team of experts devised the 90 min intervention using an empirically supported behavioral change theoretical model (COM-B). The intervention discusses multi-level factors that impact sleep and emphasizes considerations for health disparities in populations commonly served by social workers (e.g., unhoused populations, clients with substance use disorders, etc.). We assessed sleep knowledge, sleep quality, and acceptability using survey and focus group data. Results: Ninety social work students (92.2% female, 38.8% non-Hispanic white) completed pre- and post-intervention assessments. Participants demonstrated significant improvements in sleep health knowledge and their personal sleep quality. Quantitative and qualitative data revealed perceived usefulness for social work practice. Conclusions: A short online sleep education intervention can improve sleep health knowledge, offering a practical method to expand social workers' understanding of healthy sleep promotion that can be readily implemented in clinical training and practice. [ABSTRACT FROM AUTHOR]

Obtaining good quality sleep is crucial to mental health. Social work students might be particularly vulnerable to mental health challenges and insufficient sleep, which can have important implications for self-care education. Examining social work students' sleep characteristics (i.e. sleep duration and sleep quality) and health knowledge gaps can provide an important context for promoting healthy sleep among social work students. Nonetheless, the empirical literature lacks such data. The purpose of this study was to employ a sample of undergraduate and graduate social work students to: 1. assess sleep duration and sleep quality; 2. quantitatively and qualitatively examine knowledge about sleep and healthy sleep behaviors; and 3. identify sleep health knowledge gaps. Twenty-five social work students completed validated assessments and participated in a semi-structured focus group. Quantitative and qualitative data highlight poor sleep duration, poor sleep quality, and sleep health knowledge gaps among this population. Data also reveal that while students recognize the importance of sleep, they have difficulty obtaining adequate sleep due to various contextual constraints. These data support the importance of including sleep health in self-care education among social work students and highlight sleep health knowledge gaps that could be integrated into self-care education. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the effectiveness of different interventions for obstructive sleep apnea (OSA). The study found that combining acetazolamide with atomoxetine-oxybutynin did not provide any additional improvement in OSA severity compared to either agent alone. Both interventions were effective in reducing the apnea-hypopnea index (AHI). The study suggests that longer-term trials of these interventions in the appropriate populations are warranted. The document also discusses the role of compensatory muscle force in preventing OSA and potential pathways for attenuating OSA using different interventions. [Extracted from the article]

Summary: Irregular sleep and non‐optimal sleep duration separately have been shown to be associated with increased disease and mortality risk. We used data from the prospective cohort Multi‐Ethnic Study of Atherosclerosis sleep study (2010–2013) to investigate: do aging adults whose sleep is objectively high in regularity in timing and duration, and of sufficient duration tend to have increased survival compared with those whose sleep is lower in regularity and duration, in a diverse US sample? At baseline, sleep was measured by 7‐day wrist actigraphy, concurrent with at‐home polysomnography and questionnaires. Objective metrics of sleep regularity and duration from actigraphy were used for statistical clustering using sparse k‐means clustering. Two sleep patterns were identified: "regular‐optimal" (average duration: 7.0 ± 1.0 hr obtained regularly) and "irregular‐insufficient" (duration: 5.8 ± 1.4 hr obtained with twice the irregularity). Using proportional hazard models with multivariate adjustment, we estimated all‐cause mortality hazard ratios. Among 1759 participants followed for a median of 7.0 years (Q1–Q3, 6.4–7.4 years), 176 deaths were recorded. The "regular‐optimal" group had a 39% lower mortality hazard than did the "irregular‐insufficient" sleep group (hazard ratio [95% confidence interval]: 0.61 [0.45, 0.83]) after adjusting for socio‐demographics, lifestyle, medical comorbidities and sleep disorders. In conclusion, a "regular‐optimal" sleep pattern was significantly associated with a lower hazard of all‐cause mortality. The regular‐optimal phenotype maps behaviourally to regular bed and wake times, suggesting sleep benefits of adherence to recommended healthy sleep practices, with further potential benefits for longevity. [ABSTRACT FROM AUTHOR]

We utilized the comprehensive sleep assessment of the Multi-Ethnic Study of Atherosclerosis (2010–2013), a cohort of US White, Black, Chinese, and Hispanic adults and older adults (n  = 1,736; mean age = 68.3 years), to draw 13 sleep dimensions and create composite Sleep Health Scores to quantify multidimensional sleep health disparities. After age and sex adjustment in linear regression, compared with White participants, Black participants showed the greatest global sleep disparity, followed by Hispanic and Chinese participants. We estimated relative "risk" (RR) of obtaining favorable sleep compared with White adults at the component level according to race/ethnicity (lower is worse). The largest disparities were in objectively measured sleep timing regularity (RRBlack = 0.37, 95% confidence interval (CI): 0.29, 0.47; RRHispanic = 0.64, 95% CI: 0.52, 0.78; RRChinese = 0.70, 95% CI: 0.54, 0.90) and duration regularity (RRBlack = 0.55, 95% CI: 0.47, 0.65; RRHispanic = 0.76, 95% CI: 0.66, 0.88; RRChinese = 0.74, 95% CI: 0.61, 0.90) after sex and age adjustment. Disparities in duration and continuity were also apparent, and Black adults were additionally disadvantaged in % slow-wave sleep (N3), sleepiness, and sleep timing (24-hour placement). Sleep timing regularity, duration regularity, duration, and continuity may comprise a multidimensional cluster of targets to reduce racial/ethnic sleep disparities. [ABSTRACT FROM AUTHOR]

Insomnia is highly prevalent among persons with chronic pain. Although cognitive behavioral therapy for insomnia is recommended as first-line treatment for insomnia, it is underutilized. We tested the feasibility of a potentially scalable alternative – Brief Behavioral Therapy for Insomnia (BBTI) for former National Football League (NFL) players, a group with a high prevalence of chronic pain. We assessed changes in sleep, pain, and psychological health. Single-arm clinical trial of an adapted telephone-delivered BBTI intervention in 40 former NFL players with insomnia. We collected data on changes in sleep, pain, and psychological health outcomes. Among former players (30% racial/ethnic minorities), BBTI was both acceptable and feasible. BBTI was associated with improvements in sleep disturbance (primary exploratory sleep outcome, mean T-score change −6.2, 95% CI: −7.6, −4.8), sleep-related impairment (mean T-score change −5.7, 95% CI: −7.9, −3.5) and insomnia severity (mean change −5.3, 95% CI: −6.8, −3.5) post-intervention. Improvements were maintained at 2-months. BBTI was also associated with improvements in pain interference and intensity, but not psychological health. An adapted telephone-delivered BBTI is acceptable and feasible among retired players with a range of insomnia symptoms and shows promise for improving sleep and pain. These data support the need for future trials assessing BBTI's effect on both sleep and pain outcomes. [ABSTRACT FROM AUTHOR]