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Chronic insomnia disorder (CID) is commonly associated with mood disorders. The cingulate gyrus (CG) plays a critical role in the pathophysiology of CID and anxiety. However, the specific characteristics of altered brain networks in the CG in CID with anxiety remain unclear. This study aimed to investigate the characteristics of CG functional connectivity (FC) in CID with and without anxiety. Methods: Resting-state functional magnetic resonance imaging was conducted on 92 CID and 36 healthy controls (HC). CID was divided into CID with anxiety (CID-A, N = 37) and CID without anxiety (CID-NA, N = 55) groups based on anxiety scores. Using the Human Brainnetome Atlas, the subregion CG FC network was constructed. Compared with HC, CID showed significantly decreased CG FC with the precuneus, middle frontal gyrus (MFG), and hippocampus, while showing significantly increased CG FC with the middle temporal gyrus (MTG)/superior temporal gyrus (STG). In contrast, CID-A showed significantly decreased CG FC with the salience network (insular, putamen) and default mode network (MTG/STG and inferior parietal lobule), while showing significantly increased CG FC with the thalamus and MFG compared to CID-NA. Further, CID-A and CID-NA could be classified with 84.21 % accuracy by using the CG FCs as features. Among these features, the CG FC with MFG, thalamus, and putamen had the highest contribution weights. This study revealed specific changes in the brain network of the CG subregion in CID-A. Understanding these CG FC alterations can help identify potential biomarkers specific to CID-A, which may be valuable for early detection and differentiation from other CID subtypes. • To explore the cingulate gyrus (CG) subregions FC alteration in CID with anxiety (CID-A). • CID-A shown specific CG FC with default mode network and salience network. • Machine learning with CG FC features classifies CID-A accurately at 84.21 %. • The CG subregional FC alterations may contribute to potential biomarkers for CID-A. [ABSTRACT FROM AUTHOR]

Background: The present study explored the serum glutamate (Glu), glutamine (Gln), glutamic acid dehydrogenase (GAD) concentrations and the mRNA expression levels of the N-methyl-D-aspartate receptor (NMDAR) NR1 subunit in the peripheral blood of patients with insomnia disorder (ID). To our knowledge, this is the first study showing an increase in the mRNA expression levels of the NMDAR NR1 subunit in patients with ID. Methods: This study included 30 ID patients and 30 matched healthy controls. We investigated the demographic and illness information and assessed subjective sleep quality using the Pittsburgh Sleep Quality Index. The Hamilton Depression Scale-17 and Hamilton Anxiety Scale were used to evaluate the patients' symptoms of depression and anxiety, respectively. The quantifications of Glu, Gln and GAD concentrations were performed by Enzyme-linked immunosorbent assay (ELISA). Real-time PCR was used to detect the mRNA expression levels of the NMDAR NR1 subunit in peripheral blood. Results: Compared with the healthy control group, the serum Glu concentrations and the mRNA expression levels of the NMDAR NR1 subunit in the ID group were significantly higher. However, there was no significant difference in Gln and GAD between the two groups. The receiver operating characteristic (ROC) analysis showed that the mRNA expression levels of the NMDAR NR1 subunit could distinguish ID patients from healthy individuals (area under the curve: 0.758; sensitivity: 73.3%; specificity: 76.7%). A negative correlation was found between the mRNA expression levels of the NMDAR NR1 subunit for age, total duration of illness, and age of first onset in the ID group, whereas a positive correlation was detected for daytime dysfunction. Conclusion: Glutamatergic neurotransmission was abnormal in ID patients. Additionally, the mRNA expression levels of the NMDAR NR1 subunit appeared to have potential as a clinical biomarker for ID. However, the sample size of our study was limited, and future studieswith larger sample sizes are needed to further validate and explore the mechanisms involved and to assess the reliability of the biomarker. [ABSTRACT FROM AUTHOR]

Background: Chronic insomnia disorder is a common sleep disorder. Previous studies have reported increased demand for anesthetics in patients with chronic insomnia disorder. However, few studies have investigated the effective dose of dexmedetomidine for sedation in patients with chronic insomnia disorder. We aimed to determine the 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder. Methods: This is a biased coin design up-and-down sequential allocation trial in patients aged 18–65 years with chronic insomnia disorder (n = 60). The dose of dexmedetomidine for the subsequent patient was determined based on the response of the previous patient, with an interval of 0.1 µg/kg. Sedation was assessed using the bispectral index. The 95% effective dose was calculated using isotonic regression. Results: The 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder was 1.75 (95% confidence interval, 1.70–1.94) µg/kg. Four patients (6.7%) experienced bradycardia and no other adverse events were observed during the study. Conclusions: The 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder was 1.75 µg/kg. Trials registration: Chinese Clinical Trial Registry (ChiCTR2200063212); first registered 01/09 /2022. [ABSTRACT FROM AUTHOR]

Background/Objectives: Given the existence of higher suicidality in apneic individuals, this study aimed to determine the potential role played by subtypes of the comorbid insomnia disorder (CID) in the occurrence of suicidal ideation for this specific subpopulation. Methods: To perform our analyses, 1488 apneic individuals were retrospectively extracted from the Sleep Laboratory hospitalization register. Only apneic individuals with suicidal ideation highlighted during the psychiatric interview and/or with a score ≥1 on item G of the Beck Depression Inventory confirmed during the clinical interview were included in the group with suicidal ideation. The likelihood of suicidal ideation associated with CID subtypes was investigated using logistic regression analyses. Results: The prevalence of suicidal ideation was 9.3% in our sample of apneic individuals. After hierarchically introducing the significant confounders for adjustment, multivariate logistic regression analyses demonstrated that unlike short sleep duration alone and CID without short sleep duration, the likelihood of suicidal ideation was only higher for CID with short sleep duration in apneic individuals. Conclusions: Thus, we highlighted in this study that CID with short sleep duration could play a major role in higher suicidality for apneic individuals, which seems to require systematic screening and appropriate treatment of this comorbid sleep disorder to enable better management of suicidal risk in this specific subpopulation. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between sleep-aiding music and sleep-related attentional bias based on electroencephalography (EEG) functional connectivity (FC) in patients with insomnia disorder (ID), to evaluate the effectiveness of music in aiding sleep. This study included 30 participants, comprising 15 patients with ID and 15 healthy controls (HCs). Six types of music were selected for sleep aid, and a dot-probe task based on sleep-related attentional bias was utilized to collect behavioral and EEG data. Vigilance bias and disengagement bias were measured using reaction time and EEG FC. Differences in sleep-related attentional bias before and after the intervention of music were explored to evaluate the sleep-aiding effects and identify EEG biomarkers. Compared with HCs, patients with ID showed decreased sleep-related attentional bias of EEG FC between occipital-central and temporal-frontal lobes. Among the six types of music, International Standard Sleep Aid and Lullaby had a greater impact on decreasing vigilance bias in the ID group. Additionally, the International Standard Sleep Aid and Nature Sound were more effective in decreasing disengagement bias in the ID group. This study also examined the resting-state EEG FC of patients with ID before and after the intervention of music. The results showed that the FC in the temporal, frontal, and occipital lobes significantly differed before and after the intervention of music, especially with the use of International Standard Sleep Aid, Lullaby, and Alpha Sound Wave. However, it is worth noting that these three types of music showed no similarities in EEG FC, in contrast to the result of sleep-related attentional bias of EEG FC. This study found that the sleep-related attentional bias of EEG FC has more distinct characteristics when compared to resting-state EEG FC. The results suggest that the sleep-related attentional bias of EEG FC could be a potential biomarker for assessing the sleep-aiding effect of music interventions. International Standard Sleep Aid was the most effective for patients with ID among six types of sleep-aiding music. These findings could facilitate the development of personalized therapies for patients with ID. Chinese Clinical Trial Register, http://www.chictr.org.cn , ID: ChiCTR2400081608. [Display omitted] • The impact of a single music intervention on the resting-state EEG was limited. • This is the first study investigating the relationship between sleep-aiding music and sleep-related attentional bias based on EEG functional connectivity (FC). • Sleep-aiding music can decrease the sleep-related attentional bias of EEG FC between occipital-central and temporal-frontal lobes. • International Standard Sleep Aid was the most effective for patients with insomnia disorder (ID) among six types of sleep-aiding music. • Features in the sleep-related attentional bias of EEG FC were more distinctive than resting-state EEG FC. [ABSTRACT FROM AUTHOR]

Introduction: Hyperarousal has been a significant pathophysiological theory related to insomnia disorder (ID), characterized by excessive cortical activation and abnormal electroencephalogram (EEG) power during daytime or sleep. However, there is currently insufficient attention to the EEG power during rapid eye movement (REM) sleep and different stages of non-rapid eye movement (NREM) sleep. Additionally, whether the abnormal sleep EEG power in ID patients can be restored by repetitive transcranial magnetic stimulation (rTMS) remains unclear. Methods>: Data of 26 ID patients and 26 healthy controls (HCs) were included in the current observational study. The comparisons of relative power between patients and HCs at baseline in each band of each sleep stage and the changes in patients before and after rTMS treatment were performed. The correlations between relative power and behavioral measures of the patients were also investigated. Results: Abnormalities in sleep EEG relative power in the delta, beta and gamma bands of the patients were observed in NREM2, NREM3 and REM sleep. Correlations were identified between relative power and behavioral measures in ID group, primarily encompassing sleep efficiency, sleep onset latency and depression scores. Post-treatment improvements in relative power of the delta and beta band were observed in NREM2 sleep. Discussion: The relative power of sleep EEG exhibited a significant correlation with sleep measures in ID patients, and demonstrated notable differences from HCs across the delta, beta, and gamma frequency bands. Furthermore, our findings suggest that rTMS treatment may partially ameliorate relative power abnormalities in patients with ID. [ABSTRACT FROM AUTHOR]

Given the limitations of available studies, the objective of this study was to explore the role played by current and remitted major depression in the occurrence of comorbid insomnia disorder for apneic patients. Data from 1488 apneic patients were extracted from the medical reports of polysomnographic recordings available in the database of the Sleep Laboratory. The presence of comorbid insomnia disorder in these apneic patients was defined based on the diagnostic criteria of the American Academy of Sleep Medicine Work Group. The risk of comorbid insomnia disorder associated with current or remitted major depression in apneic patients was investigated using multivariate logistic regression models. After adjustment for the main confounding factors, multivariate logistic regression analyses revealed that remitted and current major depression were significantly associated with the occurrence of comorbid insomnia disorder in apneic patients. The findings of this study seem to indicate that comorbid insomnia disorder could be a residual symptom and a marker of major depression in apneic patients, which justifies the establishment of an adequate treatment for major depressive episodes and their potential residual symptoms to allow the better management of comorbid insomnia disorder and the better prevention of its potential negative consequences in this particular subpopulation. [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]

Insomnia disorder with objective short sleep duration (ISS) phenotype is a more serious biological subtype than insomnia with objective normal sleep duration (INS) phenotype, and the neuroimaging data is helpful to understand the pathophysiology of the ISS phenotype. This study was to compare the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) between the ISS phenotype and the INS phenotype. In this cross-sectional study, 55 patients with insomnia disorder were recruited, and 22 of them were defined as the ISS phenotype by the objective cardiopulmonary coupling (CPC) technique. The blood oxygen level-dependent (BOLD) sequences of all participants were obtained using the 3.0 T magnetic resonance imaging system. We analyzed and compared the ALFF, ReHo, and FC between the ISS phenotype and the INS phenotype. We also conducted Pearson's correlation analysis between significant neuroimaging biomarkers and the CPC parameters. The differences were not significant in ALFF (P FWE-corr ＞0.05) or ReHo (P FWE-corr ＞0.05) between the ISS phenotype and the INS phenotype. For the FC analysis, the ISS phenotype had a Hub-node of the left inferior occipital gyrus (IOG.L), with significantly decreased connections (p＜0.001) in the bilateral occipital, parietal, and temporal regions. The significant FCs were closely related to sleep parameters. The left inferior occipital gyrus (IOG.L), as a Hub-node with decreased functional connections, may be a potential fMRI-based biomarker of the ISS phenotype. • The ISS phenotype may be characterized by a functional MRI-based biomarker. • The left inferior occipital gyrus (IOG.L) is a Hub-node. • This Hub-node has a number of significantly decreased functional connections. [ABSTRACT FROM AUTHOR]

Objectives: This cross-sectional study aimed to evaluate sleep quality and perceived stress levels in Chinese patients with active minor recurrent aphthous stomatitis (MiRAS) lesions, as well as to investigate the potential relationship between sleep quality and perceived stress levels and the risk of MiRAS episodes. Methods: The study population consisted of individuals recruited from a Chinese cohort who underwent medical and oral examinations from March 2022 to August 2023. All participants completed a set of uniform anonymous questionnaires, which included sociodemographic characteristics, clinical information, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI) and the Perceived Stress Scale (PSS-14). Statistical analysis was conducted using the independent sample t test, Mann-Whitney U test, Pearson's chi-square test and Pearson's correlation analysis. After adjusting for potential confounders (age, gender, marital status, and education level), multivariate logistic regression analyses were performed to assess the associations of sleep quality and perceived stress levels with the risk of MiRAS episodes. Additionally, restricted cubic spline curves were constructed to visualize these correlations. Results: A total of 329 eligible volunteers participated in the study, comprising 122 Chinese MiRAS patients and 207 healthy controls without MiRAS. Compared to healthy participants, MiRAS patients exhibited significantly higher PSQI and ISI scores (p = 0.000). However, no statistically significant difference was observed between the two groups regarding PSS-14 scores or its two subscales (p > 0.05). Multiple regression analysis indicated that lower sleep quality was significantly associated with an increased risk of MiRAS episodes (p = 0.000), whereas no statistically significant relationship was found between perceived stress levels and the risk of MiRAS episodes (p > 0.05). Conclusion: Maintaining a regular bedtime and improving sleep quality may contribute to reducing the incidence and recurrence of MiRAS, while psychological intervention may be ineffective for MiRAS patients. Plain Language Summary: Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral mucosal diseases, affecting approximately 20% of the general population, with prevalence rates ranging from 0.5% to 68% across different countries. MiRAS is classified as the most common type of RAS, accounting for about 85% of RAS patients. Previous studies have identified several potential predisposing factors, including trauma, psychological disorders, genetic susceptibility, immune dysregulation, hormonal imbalance, and microbial flora disorders. However, the definitive etiology of RAS remains unknown to date. This study assessed sleep quality and perceived stress levels in Chinese patients with active MiRAS lesions using standardized measures, including the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Perceived Stress Scale (PSS-14). The results indicated that MiRAS patients had significantly higher PSQI and ISI scores compared to healthy controls, regardless of age, gender, marital status, or education level. However, no statistically significant difference was observed between the two groups concerning PSS-14 scores and its subscales. Furthermore, better sleep quality was found to be moderately associated with a reduced risk of MiRAS episodes, while perceived stress levels did not show a significant relationship with the risk. Findings from this study suggest that maintaining proper bedtime routines and improving sleep quality may help reduce both the incidence and recurrence rates of MiRAS. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic insomnia disorder is a common sleep disorder. Previous studies have reported increased demand for anesthetics in patients with chronic insomnia disorder. However, few studies have investigated the effective dose of dexmedetomidine for sedation in patients with chronic insomnia disorder. We aimed to determine the 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder. Methods This is a biased coin design up-and-down sequential allocation trial in patients aged 18–65 years with chronic insomnia disorder (n = 60). The dose of dexmedetomidine for the subsequent patient was determined based on the response of the previous patient, with an interval of 0.1 µg/kg. Sedation was assessed using the bispectral index. The 95% effective dose was calculated using isotonic regression. Results The 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder was 1.75 (95% confidence interval, 1.70–1.94) µg/kg. Four patients (6.7%) experienced bradycardia and no other adverse events were observed during the study. Conclusions The 95% effective dose of dexmedetomidine to induce adequate sedation in patients with chronic insomnia disorder was 1.75 µg/kg. Trials registration Chinese Clinical Trial Registry (ChiCTR2200063212); first registered 01/09 /2022.

Qiaoting Huang,1 Changzheng Shi,2 Saurabh Sonkusare,3 Congrui Li,1 Valerie Voon,3 Jiyang Pan1 1Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 2Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 3Department of Psychiatry, University of Cambridge, Cambridge, UKCorrespondence: Jiyang Pan, Department of Psychiatry, The First Affiliated Hospital of Jinan University, 613 West Huangpu Avenue, Guangzhou, 510630, People’s Republic of China, Tel +86 20 38688651, Email jiypan@163.com Valerie Voon, Department of Psychiatry, University of Cambridge, Box 189, Level E4, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK, Tel +44 1223 765088, Email vv247@cam.ac.ukPurpose: Converging evidence implicates the putamen in sleep-wake regulation. However, its role remains unclear. We hypothesized that metabolic abnormalities in the putamen are linked to insomnia disorder, which has not been previously addressed, and investigated putaminal N-acetylaspartate (NAA), choline (Cho), and creatine (Cr) in patients with insomnia disorder compared to healthy controls.Participants and Methods: In the present study, the concentrations of NAA, Cho, and Cr in the putamen of 23 patients with insomnia disorder and 18 healthy controls were determined using proton magnetic resonance spectroscopy. Sociodemographic, psychometric, and polysomnography data were obtained from all participants.Results: We found that the mean NAA/Cr ratio of the right putamen was significantly greater in the insomnia group compared to the control group and also greater than the left putamen within the insomnia group. The NAA/Cr ratio of the right putamen distinguished insomnia disorder from normal sleep with 78.3% sensitivity and 61.1% specificity. Furthermore, this ratio positively correlated with both objective and subjective insomnia severity and sleep quality.Conclusion: Our findings provide critical evidence for the dysfunctional putaminal metabolism of NAA/Cr in insomnia disorder, suggesting that the abnormal NAA/Cr ratio of the right putamen is linked to wakefulness in patients with insomnia disorder and may serve as a potential biomarker of insomnia disorder.Keywords: insomnia disorder, wakefulness, putamen, proton magnetic resonance spectroscopy, NAA/Cr ratio, polysomnography

Background Insomnia disorder is a common mental health condition that significantly impacts patients' lives and well-being. Traditional cognitive-behavioral therapy for insomnia (CBT-I) is an effective non-pharmacological treatment method, but its complexity, time-consuming nature, and low compliance limit its real-world application. Brief behavioral therapy for insomnia (BBT-I), based on CBT-I principles, offers comparable efficacy while being more suitable for real-world dissemination. However, the applicability of BBT-I to the Chinese population with insomnia disorder remains unclear, and research on BBT-I conducted online is lacking. Objective This study aims to investigate the efficacy of online e-aid brief behavioral therapy for insomnia (eBBT-I) delivered via WeChat Mini Program in improving insomnia symptoms among Chinese patients with insomnia disorder. Additionally, the study explores its impact on patients' sleep beliefs and attitudes. Methods This study employed a prospective non-randomized controlled design. Insomnia disorder patients from the Sleep Clinic at the First Affiliated Hospital of Jinan University between February and November 2023 were assigned to the intervention group. Insomnia disorder volunteers recruited online and offline were assigned to the control group. The intervention group received a 2-week eBBT-I (e-aid brief behavioral therapy for insomnia) treatment, while the control group received a sham intervention of mental health education. The severity of insomnia was assessed using the Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16) questionnaire before and after the intervention to evaluate its effectiveness. Results The study ultimately included 35 patients in the intervention group and 30 patients in the control group. Key outcome measures: there was a significant interaction effect between group and time for ISI scores (P0.05). After 14 days of intervention, the intervention group had lower ISI scores than the control group (P0.05). Time had a significant main effect on DBAS-16 scores (P0.05). No statistically significant difference in DBAS-16 scores was found between the two groups at baseline or after 14 days (P>0.05). However, within the intervention group, DBAS-16 scores increased after 14 days compared to baseline (P

Objective: To explore the relationship between YKL-40 level, telomere length, and different subtypes of insomnia disorder. Methods: A total of 145 individuals suffering from insomnia were enrolled and divided into four groups according to the insomniac subtypes: difficulty initiating sleep, early morning awakening, difficulty maintaining sleep, and mixed symptoms. Eighty healthy controls were also collected at the same time. Peripheral leukocyte genomic DNA was extracted, relative telomere lengths were measured using the real-time quantitative polymerase chain reaction method, and YKL-40 levels were determined using enzyme-linked immunoassay. Logistic regression modeling was used to analyze the correlation between different insomnia subtypes, YKL-40 level, and telomere length. Results: People with telomere lengths in the lowest tertile were more likely to have trouble falling asleep (odds ratio (OR) 2.13, 95% confidence interval (CI) 1.22-3.63; p = 0.03) and had a higher frequency of mixed symptoms (OR 1.49, 95% CI 1.30-2.81; p = 0.04). People in the highest tertile of YKL-40 level had an increased chance of waking up early (OR 2.98, 95% CI 1.54-5.33; p = 0.01) and more mixed symptoms (OR 1.47, 95% CI 1.22-2.79; p = 0.02). Furthermore, using receiver operating characteristic curve analysis, the area under the curve of YKL-40 level and telomere length was 0.806 and 0.746, respectively. Conclusions: Telomere length in patients with difficulty initiating sleep and mixed symptoms was significantly shortened and the level of YKL-40 in people who have early morning awakening and mixed symptoms was significantly increased. Our findings provide the first evidence that leukocyte telomere length and YKL-40 level are individually linked to mixed symptoms. [ABSTRACT FROM AUTHOR]

Abstract Background Insomnia disorder (ID) is one of the most common sleep problems, usually accompanied by anxiety and depression symptoms. Functional magnetic resonance imaging (fMRI) study suggests that both poor sleep quality and negative emotion are linked to the dysregulation of brain network related to emotion processing in ID patients. Acupuncture therapy has been proven effective in improving sleep quality and mood of ID patients, but the involved neurobiological mechanism remains unclear. We aimed to investigate the modulation effect of acupuncture on resting-state functional connectivity (rsFC) of the emotional network (EN) in patients experiencing insomnia. Methods A total of 30 healthy controls (HCs) and 60 ID patients were enrolled in this study. Sixty ID patients were randomly assigned to real and sham acupuncture groups and attended resting-state fMRI scans before and after 4 weeks of acupuncture treatment. HCs completed an MRI/fMRI scan at baseline. The rsFC values within EN were calculated, and Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), Hyperarousal Scale (HAS), and actigraphy data were collected for clinical efficacy evaluation. Results Resting-state FC analysis showed abnormalities in rsFC centered on the thalamus and dorsolateral prefrontal cortex within EN of ID patients compared to HCs. After real acupuncture treatment, rsFC of the anterior cingulate cortex, hippocampus, and amygdala were increased compared with the sham acupuncture group (p

Given the limitations of available studies, the objective of this study was to explore the role played by current and remitted major depression in the occurrence of comorbid insomnia disorder for apneic patients. Data from 1488 apneic patients were extracted from the medical reports of polysomnographic recordings available in the database of the Sleep Laboratory. The presence of comorbid insomnia disorder in these apneic patients was defined based on the diagnostic criteria of the American Academy of Sleep Medicine Work Group. The risk of comorbid insomnia disorder associated with current or remitted major depression in apneic patients was investigated using multivariate logistic regression models. After adjustment for the main confounding factors, multivariate logistic regression analyses revealed that remitted and current major depression were significantly associated with the occurrence of comorbid insomnia disorder in apneic patients. The findings of this study seem to indicate that comorbid insomnia disorder could be a residual symptom and a marker of major depression in apneic patients, which justifies the establishment of an adequate treatment for major depressive episodes and their potential residual symptoms to allow the better management of comorbid insomnia disorder and the better prevention of its potential negative consequences in this particular subpopulation.

Abstract Background Fear memory extinction is closely related to insomnia. Repetitive transcranial magnetic stimulation (rTMS) is safe and effective for treating insomnia disorder (ID), and it has been shown to be an efficient method for modulating fear extinction. However, whether rTMS can improve fear extinction memory in ID patients remains to be studied. In this study, we specifically aim to (1) show that 1 Hz rTMS stimulation could improve fear extinction memory in ID patients and (2) examine whether changes in sleep mediate this impact. Methods and design We propose a parallel group randomised controlled trial of 62 ID participants who meet the inclusion criteria. Participants will be assigned to a real rTMS group or a sham rTMS group. The allocation ratio will be 1:1, with 31 subjects in each group. Interventions will be administered five times per week over a 4-week period. The assessments will take place at baseline (week 0), post-intervention (week 4), and 8-week follow-up (week 8). The primary outcome measure of this study will be the mean change in the Pittsburgh Sleep Quality Index (PSQI) scores from baseline to post-intervention at week 4. The secondary outcome measures include the mean change in skin conductance response (SCR), fear expectation during fear extinction, Insomnia Severity Index (ISI), Zung Self-Rating Anxiety Scale (SAS), and the Zung Self-Rating Depression Scale (SDS). Discussion This study will be the first examination of the impact of rTMS on fear memory extinction in ID patients. Trial registration Chinese Clinical Trials Register ChiCTR2300076097. Registered on 25 September 2021.

Background: Insomnia disorder (ID) is one of the most common sleep problems, usually accompanied by anxiety and depression symptoms. Functional magnetic resonance imaging (fMRI) study suggests that both poor sleep quality and negative emotion are linked to the dysregulation of brain network related to emotion processing in ID patients. Acupuncture therapy has been proven effective in improving sleep quality and mood of ID patients, but the involved neurobiological mechanism remains unclear. We aimed to investigate the modulation effect of acupuncture on resting-state functional connectivity (rsFC) of the emotional network (EN) in patients experiencing insomnia. Methods: A total of 30 healthy controls (HCs) and 60 ID patients were enrolled in this study. Sixty ID patients were randomly assigned to real and sham acupuncture groups and attended resting-state fMRI scans before and after 4 weeks of acupuncture treatment. HCs completed an MRI/fMRI scan at baseline. The rsFC values within EN were calculated, and Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), Hyperarousal Scale (HAS), and actigraphy data were collected for clinical efficacy evaluation. Results: Resting-state FC analysis showed abnormalities in rsFC centered on the thalamus and dorsolateral prefrontal cortex within EN of ID patients compared to HCs. After real acupuncture treatment, rsFC of the anterior cingulate cortex, hippocampus, and amygdala were increased compared with the sham acupuncture group (p < 0.05, FDR corrected). In real acupuncture group, the rsFC value was decreased between left amygdala and left thalamus after 4 weeks of treatment compared with baseline. A trend of correlation was found that the increased rsFC value between the right amygdala and left hippocampus was positively correlated with the decreased HAMA scores across all ID patients, and the decreased left amygdala rsFC value with the left thalamus was negatively correlated with the increased sleep efficiency in the real acupuncture group. Conclusion: Our findings showed that real acupuncture could produce a positive effect on modulating rsFC within network related to emotion processing in ID patients, which may illustrate the central mechanism underlying acupuncture for insomnia in improving sleep quality and emotion regulation. Trial registration: http://www.chictr.org.cn., ChiCTR1800015282, 20/03/2018. [ABSTRACT FROM AUTHOR]

Summary This exploratory study aimed to investigate the relationship between interoceptive sensibility and quality of consciousness in individuals with insomnia disorder, in order to understand how the modulation of internal states may contribute to modifying the experience of consciousness during sleep difficulties. A total of 37 patients with insomnia disorder (mean age = 46.05 ± 18.16) and 41 healthy good sleepers (mean age = 50.2 ± 12.99) underwent a psychometric sleep and interoceptive sensibility assessment, using Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Multidimensional Assessment of Interoceptive Awareness (MAIA). Moreover, patients with insomnia disorder also completed a quality of consciousness evaluation, using the Phenomenology of Consciousness Inventory (PCI). Patients with insomnia disorder exhibited heightened interoceptive sensibility, particularly in noticing body sensations (p < 0.0001) and emotional awareness (p = 0.032), along with diminished abilities in attention regulation (p = 0.040), not‐worrying (p = 0.001), and trusting (p = 0.002). Furthermore, correlations between interoceptive sensibility and multiple aspects of the consciousness state during the insomnia night were identified. Specifically, higher emotional awareness was linked to a 2.49‐fold increase in the likelihood of subjectively experiencing altered consciousness states during insomnia. The study sheds light on the relationship between interoceptive sensibility and the subjective state of consciousness during insomnia, emphasising the importance of exploring and considering interoception as part of the therapeutic process for insomnia disorder. Given the exploratory nature of the study and the increased risk of type‐I error from numerous correlations, the results should be interpreted with caution. Further research is needed to validate and confirm their robustness. [ABSTRACT FROM AUTHOR]

Summary: Diagnostic manuals describe insomnia disorder (ID) characterised by fatigue and sleepiness as diurnal consequences of nocturnal symptoms. However, patients with ID do not frequently report sleepiness in the clinical setting. The present study aimed to investigate subjective sleepiness in ID measured through the Epworth Sleepiness Scale (ESS) and its independence towards daytime functioning and fatigue, and to evaluate cognitive behavioural therapy for insomnia (CBT‐I) improvement in daytime consequences and their relationship to sleepiness and fatigue. We retrospectively collected the ESS evaluation in a large sample of 105 healthy controls (HCs), 671 patients with ID, and 602 patients with sleep disorders characterised by excessive daytime sleepiness (EDS). Moreover, we conducted a pre–post evaluation of the ESS in a sub‐sample of patients with ID who underwent CBT‐I. Component 2 of the Insomnia Severity Index and Profile of Mood States–Fatigue Inertia Scale was used to evaluate daytime functioning and fatigue. Patients with ID reported ESS levels comparable to that observed in HCs and significantly lower than the EDS group. No significant correlation arose between ESS and the diurnal impact of the disorder, suggesting the independence between daytime functioning and sleepiness in ID. Contrarily, insomnia severity and diurnal impact significantly correlated with fatigue. Data showed a statistically significant increase in sleepiness after CBT‐I, despite significantly improving daytime consequences and fatigue. Although diagnostic manuals report sleepiness and fatigue as daytime consequences of sleep symptoms in patients with ID, these retrospective data indicate a dissociation between these entities. This evidence aligns with the core feature of ID: the hyperarousal status that pervades patients also during wakefulness. [ABSTRACT FROM AUTHOR]

Purpose: Major Depressive Disorder (MDD) and Insomnia Disorder (ID) are prevalent psychiatric conditions often occurring concurrently, leading to substantial impairment in daily functioning. Understanding the neurobiological underpinnings of these disorders and their comorbidity is crucial for developing effective interventions. This study aims to analyze changes in functional connectivity within attention networks and default mode networks in patients with depression and insomnia. Methods: The functional connectivity alterations in individuals with MDD, ID, comorbid MDD and insomnia (iMDD), and healthy controls (HC) were assessed from a cohort of 174 participants. They underwent rs-fMRI scans, demographic assessments, and scale evaluations for depression and sleep quality. Functional connectivity analysis was conducted using region-of-interest (ROI) and whole-brain methods. Results: The MDD and iMDD groups exhibited higher Hamilton Depression Scale (HAMD) scores compared to HC and ID groups (P < 0.001). Both ID and MDD groups displayed enhanced connectivity between the left and right orbital frontal cortex compared to HC (P < 0.05), while the iMDD group showed reduced connectivity compared to HC and ID groups (P < 0.05). In the left insula, reduced connectivity with the right medial superior frontal gyrus was observed across patient groups compared to HC (P < 0.05), with the iMDD group showing increased connectivity compared to MDD (P < 0.05). Moreover, alterations in functional connectivity between the left thalamus and left temporal pole were found in iMDD compared to HC and MDD (P < 0.05). Correlation analyses revealed associations between abnormal connectivity and symptom severity in MDD and ID groups. Conclusions: Our findings demonstrate distinct patterns of altered functional connectivity in individuals with MDD, ID, and iMDD compared to healthy controls. These findings contribute to a better understanding of the pathophysiology of depression and insomnia, which could be used as a reference for the diagnosis and treatments of these patients. [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]

The article offers information on evidence-based approaches for treating insomnia disorder. Topics include the characteristics and diagnostic criteria of insomnia disorder; the endorsement of cognitive-behavioral therapy for insomnia (CBT-I) as the first-line treatment by the Australasian Sleep Association (ASA); and the availability of evidence-based treatment manuals, tailored recommendations for specific populations, and digital programs for delivering CBT-I.

Background: Chronic insomnia disorder (CID) is usually associated with Generalized Anxiety Disorder (GAD), which may change brain structure and function. However, the possible brain markers, imaging characteristics, and pathophysiology are unknown. Objective: To look at the probable brain markers, imaging characteristics, and pathogenesis of CID in combination with GAD. Methods: A total of 57 patients with CID concomitant GAD and 57 healthy controls (HC) were enrolled. Voxel-based morphometry (VBM) and functional connectivity (FC) were utilized to measure gray matter volume (GMV) and functional changes. Correlation analysis was utilized to identify relationships between brain changes and clinical characteristics. Results: Patients had decreased GMV in the left cerebellum, right cerebellar peduncle, and left insula; increased FC between the left cerebellum and right angular gyrus, as well as between the left insula and anterior left cingulate gyrus; and decreased FC in several areas, including the left cerebellum with the middle left cingulate gyrus and the left insula with the left superior postcentral gyrus. These brain changes related to CID and GAD. These data could be used to identify relevant brain markers, imaging features, and to better understand the etiology. Conclusion: The intensity of insomnia in patients was strongly related to the severity of anxiety. The lower GMV in the cerebellum could be interpreted as an imaging characteristic of CID. Reduced GMV in the insula, as well as aberrant function in the cingulate gyrus and prefrontal lobe, may contribute to the pathophysiology of CID and GAD. Abnormal function in the postcentral gyrus and angular gyrus may be associated with patients' clinical complaints. [ABSTRACT FROM AUTHOR]

Purpose: From a clinical point of view, how to force a transition from insomnia brain state to healthy brain state by external driven stimulation is of great interest. This needs to define brain state of insomnia disorder as metastable substates. The current study was to identify recurrent substates of insomnia disorder in terms of probability of occurrence, lifetime, and alternation profiles by using leading eigenvector dynamics analysis (LEiDA) method. Methods: We enrolled 32 patients with insomnia disorder and 30 healthy subjects. We firstly obtained the BOLD phase coherence matrix from Hilbert transform of BOLD signals and then extracted all the leading eigenvectors from the BOLD phase coherence matrix for all subjects across all time points. Lastly, we clustered the leading eigenvectors using a k-means clustering algorithm to find the probabilistic metastable substates (PMS) and calculate the probability of occurrence and associated lifetime for substates. Results: The resulting 3 clusters were optimal for brain state of insomnia disorder and healthy brain state, respectively. The occurred probabilities of the PMS were significantly different between the patients with insomnia disorder and healthy subjects, with 0.51 versus 0.44 for PMS-1 (p < 0.001), 0.25 versus 0.27 for PMS-2 (p = 0.051), and 0.24 versus 0.29 for PMS-3 (p < 0.001), as well as the lifetime (in TR) of 36.65 versus 33.15 for PMS-1 (p = 0.068), 14.36 versus 15.43 for PMS-2 (p = 0.117), and 14.80 versus 16.34 for PMS-3 (p = 0.042). The values of the diagonal of the transition matrix were much higher than the probabilities of switching states, indicating the metastable nature of substates. Conclusion: The resulted probabilistic metastable substates hint the characteristic brain dynamics of insomnia disorder. The results may lay a foundation to help determine how to force a transition from insomnia brain state to healthy brain state by external driven stimulation. [ABSTRACT FROM AUTHOR]

Background: Insomnia is a common sleep disorder with significant negative impacts on emotional states; however, the underlying mechanism of insomnia with comorbid emotional dysregulation remains largely unknown. The salience network (SN) plays an important role in both sleep and emotional regulation. The study aimed to explore the specific alterations in functional connectivity (FC) within the SN in insomnia patients. Methods: A total of 30 eligible patients with insomnia disorder (ID group) and 30 healthy controls (HC group) underwent resting-state functional magnetic resonance imaging (fMRI) scanning and psychometric assessments. Differences in FC within the SN were examined using seed-based region-to-region connectivity analysis. Results: Compared with healthy controls, patients with insomnia showed increased FC within the SN, mainly between the anterior cingulate cortex (ACC) and right superior frontal gyrus (SFG), the right SFG and right supramarginal gyrus (SMG), and between the right insular (INS) and left SMG (P<0.05). Additionally, significant correlations were observed between increased FC and the Hamilton Depression Rating Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), and Hamilton Anxiety Rating Scale (HAMA) scores (P<0.05, after Bonferroni correction). Conclusions: These results suggest that increased FC within the SN may be related to poor sleep quality and negative emotions, highlighting the importance of the SN in the pathophysiological mechanisms of insomnia with comorbid emotional dysregulation. [ABSTRACT FROM AUTHOR]

Purpose: Sleep State Misperception (SSM) is described as the tendency of Insomnia Disorder (ID) patients to overestimate Sleep Latency (SL) and underestimate Total Sleep Time (TST). Literature exploring topographical components in ID with SSM is scarce and does not allow us to fully understand the potential mechanisms underlying this phenomenon. This study aims to evaluate the existence of sleep EEG topography alterations in ID patients associated with SSM compared to Healthy Controls (HC), focusing on two distinct periods: the Sleep Onset (SO) and the whole night. Methods: Twenty ID patients (mean age: 43.5 ± 12.7; 7 M/13F) and 18 HCs (mean age: 41.6 ± 11.9; 8 M/10F) underwent a night of Polysomnography (PSG) and completed sleep diaries the following morning upon awakening. Two SSM indices, referring to the misperception of SL (SLm) and TST (TSTm), were calculated by comparing objective and subjective sleep indices extracted by PSG and sleep diary. According to these indices, the entire sample was split into 4 sub-groups: ID +SLm vs HC –SLm; ID +TSTm vs HC –TSTm. Results: Considering the SO, the two-way mixed-design ANOVA showed a significant main effect of Groups pointing to a decreased delta/beta ratio in the whole scalp topography. Moreover, we found a significant interaction effect for the sigma and beta bands. Post Hoc tests showed higher sigma and beta power in anterior and temporo-parietal sites during the SO period in IDs +SLm compared to HC –SLm.Considering the whole night, the unpaired t-test revealed in IDs +TSTm significantly lower delta power during NREM, and lower delta/beta ratio index during NREM and REM sleep compared to HCs –TSTm.Finally, we found diffuse significant negative correlations between SSM indices and the delta/beta ratio during SO, NREM, and REM sleep. Conclusion: The main finding of the present study suggests that higher SL overestimation and TST underestimation are both phenomena related to diffuse cortical hyperarousal interpreted as a sleep state-independent electrophysiological correlate of the SSM, both during the SO and the whole night.

Background: Sleep is one of the most important psychological and physiological processes for brain function and mental health that control human health. Sleep quality is essential in middle-aged society, and sleep problems in this society are recognized as a main risk factor for mental and physical health problems. So far, the effectiveness of various treatments have been performed to improve sleep quality in middle-aged people, but no study has compared cognitive behavioral therapy and acceptance and commitment therapy. Aims: The present study was conducted with the aim of comparing the effectiveness of cognitive behavioral therapy and acceptance and commitment-based therapy on improving insomnia in middle-aged people. Methods: The research method was experimental with a pre-test and post-test design with a control group and a three-month follow-up. The statistical population of this research included all middle-aged men and women suffering from insomnia who referred to health centers in Hamedan city in 2022. 60 people were selected as available sampling and randomly divided into 3 groups of 20 people (two experimental groups and one control group), cognitive behavioral therapy, commitment and acceptance therapy and control group. The measurement tool in this research was the insomnia disorder questionnaire of Homai Maaz et al. (2023). The experimental groups were subjected to cognitive behavioral therapy based on acceptance and commitment for 9 sessions of 75 minutes respectively, and the control group received the usual treatment. Results: The findings showed that after the intervention, both treatment methods improved the insomnia disorder compared to the control group, and the treatment results were maintained in the follow-up period (p

Qian Yang,1 Lingfeng Liu,1 Jing Wang,2 Ying Zhang,2 Nan Jiang,3 Meiyun Zhang2 1Tianjin Union Medical Center, Tianjin Medical University, Tianjin, 300070, People’s Republic of China; 2Department of Neurology, Tianjin Union Medical Center, Tianjin, 300121, People’s Republic of China; 3School of Mechanical Engineering, Tianjin University, Tianjin, 300354, People’s Republic of ChinaCorrespondence: Meiyun Zhang, Email zmy22202@aliyun.comObjective: To investigate the changes in the wavelet entropy during wake and different sleep stages in patients with insomnia disorder.Methods: Sixteen patients with insomnia disorder and sixteen normal controls were enrolled. They underwent scale assessment and two consecutive nights of polysomnography (PSG). Wavelet entropy analysis of electroencephalogram (EEG) signals recorded from all participants in the two groups was performed. The changes in the integral wavelet entropy (En) and individual-scale wavelet entropy (En(a)) during wake and different sleep stages in the two groups were observed, and the differences between the two groups were compared.Results: The insomnia disorder group exhibited lower En during the wake stage, and higher En during the N3 stage compared with the normal control group (all P < 0.001). In terms of En(a), patients with insomnia disorder exhibited lower En(a) in the β and α frequency bands during the wake stage compared with normal controls (β band, P < 0.01; α band, P < 0.001), whereas they showed higher En(a) in the β and α frequency bands during the N3 stage than normal controls (β band, P < 0.001; α band, P < 0.001).Conclusion: Wavelet entropy can reflect the changes in the complexity of EEG signals during wake and different sleep stages in patients with insomnia disorder, which provides a new method and insights about understanding of pathophysiological mechanisms of insomnia disorder. Wavelet entropy provides an objective indicator for assessing sleep quality.Keywords: insomnia disorder, sleep stages, wavelet entropy, polysomnography

Objectives: To examine serum concentrations of neurotensin, pannexin-1 and sestrin-2, and their correlations with subjective and objective sleep quality and cognitive function in the patients with chronic insomnia disorder (CID). Methods: Sixty-five CID patients were enrolled continuously and fifty-six good sleepers in the same period were served as healthy controls (HCs). Serum levels of neurotensin, pannexin-1 and sestrin-2 were measured by enzyme-linked immunosorbent assays. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and polysomnography, and mood was evaluated by 17-item Hamilton Depression Rating Scale. General cognitive function was assessed with the Chinese-Beijing Version of Montreal Cognitive Assessment and spatial memory was evaluated by Blue Velvet Arena Test (BVAT). Results: Relative to the HCs, the CID sufferers had higher levels of neurotensin (t=5.210, p<0.001) and pannexin-1 (Z=4.169, p<0.001), and lower level of sestrin-2 (Z=2.438, p=0.015). In terms of objective sleep measures, pannexin- 1 was positively associated with total sleep time (r=0.562, p=0.002) and sleep efficiency (r=0.588, p=0.001), and negatively with wake time after sleep onset (r=0.590, p=0.001) and wake time (r=0.590, p=0.001); sestrin-2 was positively associated with percentage of rapid eye movement sleep (r=0.442, p=0.016) and negatively with non-rapid eye movement sleep stage 2 in the percentage (r=0.394, p=0.034). Adjusted for sex, age and HAMD, pannexin-1 was still associated with the above objective sleep measures, but sestrin-2 was only negatively with wake time (r=0.446, p=0.022). However, these biomarkers showed no significant correlations with subjective sleep quality (PSQI score). Serum concentrations of neurotensin and pannexin-1 were positively associated with the mean erroneous distance in the BVAT. Adjusted for sex, age and depression, neurotensin was negatively associated with MoCA score (r=0.257, p=0.044), pannexin-1 was positively associated with themean erroneous distance in the BVAT (r=0.270, p=0.033). [ABSTRACT FROM AUTHOR]

In this study, the 10-year cardiovascular risk associated with comorbid sleep disorders (insomnia disorder, obstructive sleep apnea syndrome, and COMISA [comorbid insomnia and sleep apnea]) was investigated for patients with major depression. To enable our analysis, 607 patients with major depression were selected from the data register of the Sleep Unit. High 10-year cardiovascular risk was considered present when the Framingham Risk Score was ≥10%. The 10-year cardiovascular risk associated with comorbid sleep disorders has been assessed using logistic regression analyzes. High 10-year cardiovascular risk is significant (40.4%) in patients with major depression. After successive introduction of the different confounders, multivariate logistic regressions showed that for patients with major depression high 10-year cardiovascular risk was significantly associated with COMISA but was not significantly associated with insomnia disorder or obstructive sleep apnea syndrome alone. Thus, these results highlight the existence of a negative synergistic action between insomnia disorder and obstructive sleep apnea syndrome on the 10-year cardiovascular risk in patients with major depression, which demonstrates the importance of researching and treating COMISA to improve the prognosis of this specific population subgroup characterized by higher cardiovascular morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background : Insomnia disorder is associated with an impairment in cognitive performance. Doxepin and zolpidem have been found to be effective in improving sleep. In this study, we aimed to compare the effects of doxepin and zolpidem on sleep structure and executive function in patients with insomnia disorder. Methods: Patients with primary insomnia were randomly assigned to receive doxepin 6 mg/day orally or zolpidem 5–10 mg/day orally. Polysomnography (PSG) and the Pittsburgh Sleep Quality Index (PSQI) were used at baseline and after the 8-week treatment to compare clinical efficacy in the two groups. Safety was assessed using the Treatment Emergent Symptom Scale (TESS). Executive function was evaluated using the Wisconsin sorting card test (WSCT). Results: Of 120 patients enrolled in the study, 60 participants were assigned to each group. A total of 109 participants (53 in the doxepin group and 56 in the zolpidem group) completed the study. After treatment, the wake after sleep onset (WASO) and total sleep time (TST) values in the doxepin group were 80.3 ± 21.4 min and 378.9 ± 21.9 min, respectively, which were significantly better than those in the zolpidem group (132.9 ± 26.5 min and 333.2 ± 24.2 min, respectively; (P < 0.05)). The sleep onset latency (SOL) value in the zolpidem group (20.3 ± 4.7 min) was significantly better than that in the doxepin group (28.2 ± 5.6 min; P < 0.05). The sleep efficiency (SE) in the doxepin group was 77.8 ± 4.2%, which was significantly better than that in the zolpidem group (68.6 ± 5.0%; P < 0.05). The PSQI score of the doxepin group was 6.1 ± 1.1, which was significantly lower than that in the zolpidem group (7.9 ± 1.9; P < 0.05). The treatment adverse events in the doxepin group was 23.3%, which was significantly higher than that in the zolpidem group (13.3%; P < 0.05). The WSCT showed a significant improvement in persistent errors (PE), random errors (RE), and categories in the two groups after 8-week treatment, and the improvement in RE and the categories was more obvious in the doxepin group (P < 0.05). Conclusions: Both doxepin and zolpidem were found to be effective in improving sleep quality, but the effects exhibited different patterns. Doxepin improved executive function more effectively than zolpidem in patients with insomnia disorder. [ABSTRACT FROM AUTHOR]

Summary: Previous studies indicated that further investigation is needed to understand how insomnia disorder interacts with emotional processes. The present study is an ecological momentary assessment evaluating the link between emotional and sleep alterations in patients with insomnia. Physiological (heart rate and heart rate variability) and subjective (sleep and emotions) indices were observed for 5 days in patients with insomnia disorder (n = 97), good sleepers under self‐imposed sleep restriction (n = 41), and good sleepers with usual amount of sleep (n = 45). We evaluated differences in emotion regulation strategies and in valence and variability of emotional experiences. Over 5 days, patients with insomnia showed increased sleep and emotional difficulties compared with both control groups. Independent from group allocation, days with more negative emotions were associated with higher sleep alterations. Longer wake episodes at night and higher diurnal heart rate were associated with increased variations in emotion experienced during the day. Only in patients with insomnia, use of adaptive emotion regulation strategies was associated with higher sleep efficiency. Our data showed that alterations in sleep and emotional processes are closely linked. A combination of strategies targeting both sleep and emotional processes appears promising in the prevention and treatment of insomnia disorder. [ABSTRACT FROM AUTHOR]

Insomnia disorder is the most common sleep disorder, which interacts with other diseases, causing health damage to human body and imposing a significant socio-economic burden. Currently, there have been further advancements in subtypes of insomnia disorder, comorbidity research, mechanistic hypotheses, assessment strategies, and treatment methods. With the advent of the information age, digital platforms can integrate early warning, accurate assessment and diagnosis, treatment methods, and later follow-up for insomnia disorder to establish a comprehensive and standardized system for the treatment and management of insomnia disorder, helping to alleviate a rising morbidity rate and save healthcare costs. [ABSTRACT FROM AUTHOR]

The global coronavirus disease 2019 (COVID-19) pandemic seriously affected people's lives. We evaluated anxiety and depression among patients with insomnia in northeast China during the first wave and release of COVID-19, providing a basis for the clinical diagnosis and treatment of insomnia. We enrolled 4211 patients with insomnia from January 2016 to February 2020, August 2020 to February 2022, August 2022 to December 2022, and January 2023 to February 2023, from our institution. Sleep quality was evaluated using the Athens Insomnia Scale, Insomnia Severity Index (ISI), and Pittsburgh sleep quality index (PSQI), while mood disorder and fatigue were evaluated using the Hhospital anxiety and depression scale (HAD), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Fatigue Scale-14 (FS-14). Insomnia with depression increased in prevalence after COVID-19 compared with before (12.8 % vs. 15.3 %, P < 0.05), while the age of patients decreased [(50.2 ± 15.2) vs. (47.5 ± 16.8), P < 0.05]. The number of patients with insomnia and severe depression increased compared with before COVID-19 (20.3 % vs. 25.3 %, P < 0.05). A higher proportion of patients with insomnia for >2 years had depression (P < 0.05). As the epidemic subsided, insomnia increased among young and male patients (young patients: 55.2 % vs. 37.0 %; male patients: 41 % vs. 27.4 %, respectively; P < 0.05). The proportion of patients with insomnia with anxiety and depression increased (53.8 % vs. 51.8 %， P < 0.05), the proportion with moderate to severe anxiety increased (7.6 % vs. 13.5 %, P < 0.05), and moderate and severe depression decreased (moderate: 25.6 % vs. 19.1 %, severe: 25.8 % vs. 20.3 %, P < 0.05, respectively). Middle-aged and elderly patients had higher PQSI scores in sleep latency, habitual sleep efficiency, subjective sleep quality, and use of sleep medications than young patients (P < 0.05). The PSQI score was positively correlated with the PHQ-9 score (r = 0.526), GAD-7 score (r = 0.563), and FS-14 score (r = 0.316) (P < 0.05). The study was single-center, the sample size was small, and assessment data were lacking from early in the epidemic. The scale is subjective, which may affect the accuracy. Insomnia with depression increased during COVID-19. The patients were younger than before the epidemic, and a higher proportion with insomnia for >2 years had depression. The proportion of patients with insomnia with anxiety and depression was higher after the epidemic period, and the degree worsened. The proportion of insomnia with depression decreased after the epidemic period, and the degree alleviated. The proportion of young male patients with insomnia increased. Middle aged and elderly patients with insomnia had poor sleep quality, which was positively correlated with anxiety, depression, and fatigue. • Insomnia with depression increased in prevalence after COVID-19, while the age of patients decreased. • As the epidemic subsided, insomnia increased among young and male patients. • Middle-aged and older patients had worse sleep quality than young patients, and sleep quality was associated with anxiety, depression, and fatigue. [ABSTRACT FROM AUTHOR]

Patients with insomnia are often accompanied by cognitive dysfunction, which seriously affects the quality of life of patients. Repetitive transcranial magnetic stimulation (rTMS) can induce brain neuroplasticity, regulate brain cognitive function and inhibitory control ability. To explore the intervention effect of rTMS on conflict control and sleep quality in patients with insomnia. In this single-blind, randomized controlled trial, 39 people with insomnia disorder were randomly divided into real stimulation group and sham stimulation group. The stimulation parameters were stimulation frequency 1 Hz, stimulation intensity 80 % resting motor threshold (RMT), total pulse number 1500 times, time 25 min, and the whole course of treatment lasted 7 days. The Insomnia Severity Index(ISI)、Pittsburgh Sleep Quality Index(PSQI)、Multidimensional Fatigue Inventory(MFI) and Beck Anxiety Inventory(BAI) were assessed at pretest (baseline) and posttest (day 7 after intervention), and the color-word stroop task was used to measure the conflict control ability of the subjects. The sleep quality, correct rate and reaction time of the posttest in the real stimulus group were higher than those in the pretest. However, there was no significant difference between the pretest and posttest in the sham stimulation group. rTMS stimulation of the left dorsolateral prefrontal cortex (LDLPFC) in patients with insomnia can significantly improve the conflict control ability and sleep quality of patients with insomnia. [ABSTRACT FROM AUTHOR]

Background: Sleeping in an unfamiliar environment, such as a sleep laboratory, is thought to disturb sleep in healthy individuals and could express a hyperarousal state called the first night effect. Insomnia disorder (ID) is a highly prevalent health problem characterized by increased arousal during the night and daytime. Whether or not a similar phenomenon occurs in patients with ID is unclear. This study aimed to investigate the effect of an unfamiliar environment on the sleep of patients with ID. Methods: In an unfamiliar sleep laboratory, polysomnographic recording testing was performed for two consecutive nights in patients with ID and age- and sex-matched healthy control subjects (HC). We collected sleep diaries and questionnaires regarding sleep, medical conditions, psychological status, and health history. Sleep continuity and architecture in both groups were compared and analyzed for two consecutive nights. Results: Participants with ID (n = 39) and HC (n = 35) demonstrated differentially poor sleep on laboratory adaptation after exposure to the sleep laboratory. Patients with ID had longer rapid eye movement (REM) latency on the first night than on the second sleep night. HC showed increased duration and percentage of N1, decreased duration and percentage of N3, and decreased REM percentage during initial nights compared to subsequent nights. The other sleep variables showed no differences between the first and second sleep nights in patients with ID and HC. Conclusions: An unfamiliar sleep environment does not aggravate the disruption of sleep continuity and sleep architecture but only affects the REM latency in patients with ID compared with HC. [ABSTRACT FROM AUTHOR]

Abstract Background Insomnia disorder (ID) seriously affects people’s daily life. Difficulty falling asleep is the most commonly reported complaint in patients with ID. However, the mechanism of prolonged sleep latency (SL) is still obscure. The aim of our present study was to investigate the relationship between prolonged SL and alterations in spontaneous neural activity and brain functional connectivity (FC) in ID patients using functional magnetic resonance imaging (fMRI). Methods A total of 52 insomniacs with difficulty falling asleep and 30 matched healthy controls (HCs) underwent resting-state fMRI. The amplitude of low-frequency fluctuation (ALFF) was measured and group differences were compared. The peak areas with significantly different ALFF values were identified as the seed regions to calculate FC to the whole brain. SL was assessed by a wrist actigraphy device in ID patients. The Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA), and Hyperarousal Scale (HAS) were evaluated in both ID patients and HCs. Finally, correlation analyses were performed between the clinical features and FC/ALFF values. Results ID patients showed higher PSQI, HAMA, HAS scores than HCs. The functional MRI results indicated increased ALFF value in the left insula and right amygdala and decreased ALFF value in the right superior parietal lobe (SPL) in ID patients. The seed-based FC analysis demonstrated increased FC between the left insula and the bilateral precentral gyrus and FC between the right amygdala and the left posterior cingulate cortex (PCC) in patients with ID. Correlation analysis indicated that the increased FC value of the right amygdala-left PCC was positively correlated with SL measured by actigraphy. Conclusion This study revealed abnormal regional spontaneous fluctuations in the right amygdala, left insula, and right SPL, as well as increased FC in the left insula-precentral and right amygdala-left PCC. Moreover, the prolonged SL was positively correlated with the abnormal FC in the right amygdala-left PCC in ID patients. The current study showed the correlation between prolonged SL and the abnormal function of emotion-related brain regions in ID patients, which may contribute to a better understanding of the neural mechanisms underlying difficulty falling asleep in patients with ID. Clinical Trial Registration http://www.chictr.org.cn ., ChiCTR1800015282. Registered on 20th March 2018.

It is not clear whether and how insomnia disorder (ID) impairs response inhibition ability. Fronto-striatal functional connectivity (FC) plays a critical role in response inhibition and is found be abnormal in patients with ID. In this study, we examined whether insomnia symptoms impair response inhibition in a large non-clinical sample and whether impaired response inhibition is related to abnormal fronto-striatal FC. One hundred and fifteen young ID patients and 160 age and sex-matched healthy controls (HC) underwent resting-state functional magnetic response imaging scans and performed the stop-signal task (SST). Performance of SST, Gray Matter Volumes (GMVs), and connections of brain regions related to fronto-striatal circuits was compared between groups. Further examined the association between response inhibition impairment and fronto-striatal FC. The behavioral results showed that patients with ID had significantly longer stop-signal reaction time (SSRT) compared with the HC, reflecting the impaired response inhibition among IDs. Brain imaging results showed IDs had decreased GMVs of the Right Superior Frontal (SFG) and left Supplementary Motor area (SMA). Seed-based FC results showed that compared to HC, the ID showed decreased FC between left SMA and left Paracentral lobule, left SMA and right SMA, and right SFG and right Orbital Middle Frontal gyrus, and increased FC between right SFG and right putamen. Meanwhile, the FC between right SFG and putamen was positively correlated with SSRT in IDs. The current study found significantly impaired response inhibition among ID and this impairment may be related to abnormal fronto-striatal FC in ID. [ABSTRACT FROM AUTHOR]

Summary: Polysomnographic studies have been performed to investigate the first‐night effect in insomnia disorder. However, these studies have revealed discrepant findings. This meta‐analysis aimed to summarise and quantify the characteristics of the first‐night effect in insomnia disorder. We performed a systematic search of the PubMed, Medline, EMBASE, Web of Science and PsycINFO databases to identify studies published through October 2019. A total of 11,862 articles were identified, and seven studies with eight independent populations were included in the meta‐analysis. A total of 639 patients with insomnia disorder and 171 healthy controls underwent more than 2 consecutive nights of in‐laboratory polysomnography. Pooled results demonstrated that both variables of sleep continuity and sleep architecture, other than slow‐wave sleep were significantly altered in the first‐night effect in insomnia disorder. Furthermore, the results indicated that patients with insomnia disorder had a disruption of sleep continuity in the first‐night effect, including increased sleep onset latency and reduced total sleep time, compared to healthy controls. Overall, the findings show that patients with insomnia disorder experience the first‐night effect, rather than reverse first‐night effect, and the profiles of the first‐night effect in patients with insomnia are different from healthy controls. These indicate that an adaptation night is necessary when sleep continuity and sleep architecture is to be studied in patients with insomnia disorder. More well‐designed studies with large samples are needed to confirm the results. [ABSTRACT FROM AUTHOR]

Sleep state misperception (SSM) is a common issue in insomnia disorder (ID), causing a discrepancy between objective and subjective sleep/wake time estimation and increased daytime impairments. In this context, the hyperarousal theory assumes that sustained central nervous system activation contributes to the SSM. This study investigates factors influencing SSM during sleep latency (SL) and total sleep time (TST). Objective polysomnographic sleep variables (the alpha density index, latency-to-sleep stages and the first K-complex, and Rapid Eye Movement (REM) arousal density) and subjective sleep indices, taken from sleep diaries, were analyzed in 16 ID patients. Correlation analyses revealed a positive association between the degree of SL misperception (SLm) and the percentage of epochs that contained a visually scored stereotyped alpha rhythm during objective SL. A regression analysis showed that the REM arousal density and alpha density index significantly predicted TST misperception (TSTm). Furthermore, the degree of SLm was associated with an increased probability of transitioning from stage 1 of non-REM sleep to wakefulness during subjective SL. These findings support the role of hyperarousal in SSM and highlight the importance of alpha activity in unravelling the heterogeneous underpinnings of SSM. [ABSTRACT FROM AUTHOR]

Background and purpose: The diagnosis of sleep–wake disorders (SWDs) is challenging because of the existence of only few accurate biomarkers and the frequent coexistence of multiple SWDs and/or other comorbidities. The aim of this study was to assess in a large cohort of well‐characterized SWD patients the potential of a data‐driven approach for the identification of SWDs. Methods: We included 6958 patients from the Bernese Sleep Registry and 300 variables/biomarkers including questionnaires, results of polysomnography/vigilance tests, and final clinical diagnoses. A pipeline, based on machine learning, was created to extract and cluster the clinical data. Our analysis was performed on three cohorts: patients with central disorders of hypersomnolence (CDHs), a full cohort of patients with SWDs, and a clean cohort without coexisting SWDs. Results: A first analysis focused on the cohort of patients with CDHs and revealed four patient clusters: two clusters for narcolepsy type 1 (NT1) but not for narcolepsy type 2 or idiopathic hypersomnia. In the full cohort of SWDs, nine clusters were found: four contained patients with obstructive and central sleep apnea syndrome, one with NT1, and four with intermixed SWDs. In the cohort of patients without coexisting SWDs, an additional cluster of patients with chronic insomnia disorder was identified. Conclusions: This study confirms the existence of clear clusters of NT1 in CDHs, but mainly intermixed groups in the full spectrum of SWDs, with the exception of sleep apnea syndromes and NT1. New biomarkers are needed for better phenotyping and diagnosis of SWDs. [ABSTRACT FROM AUTHOR]

Background: Sleep restriction therapy (SRT) is a behavioural therapy for insomnia. Aim: To conduct a process evaluation of a randomised controlled trial comparing SRT delivered by primary care nurses plus a sleep hygiene booklet with the sleep hygiene booklet only for adults with insomnia disorder. Design and setting: A mixed-methods process evaluation in a general practice setting. Method: Semi-structured interviews were conducted in a purposive sample of patients receiving SRT, the practice nurses who delivered the therapy, and also GPs or practice managers at the participating practices. Qualitative data were explored using framework analysis, and integrated with nurse comments and quantitative data, including baseline Insomnia Severity Index score and serial sleep efficiency outcomes to investigate the relationships between these. Results: In total, 16 patients, 13 nurses, six practice managers, and one GP were interviewed. Patients had no previous experience of behavioural therapy, needed flexible appointment times, and preferred face-to-face consultations; nurses felt prepared to deliver SRT, accommodating patient concerns, tailoring therapy, and negotiating sleep timings despite treatment complexity and delays between training and intervention delivery. How the intervention produced change was explored, including patient and nurse interactions and patient responses to SRT. Difficulties maintaining SRT, negative attitudes towards treatment, and low self-efficacy were highlighted. Contextual factors, including freeing GP time, time constraints, and conflicting priorities for nurses, with suggestions for alternative delivery options, were raised. Participants who found SRT a positive process showed improvements in sleep efficiency, whereas those who struggled did not. Conclusion: SRT was successfully delivered by practice nurses and was generally well received by patients, despite some difficulties delivering and applying the intervention in practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Insomnia disorder (ID) is a persistent difficulty sleeping, often accompanied by anxiety and depression, which seriously reduces a person’s quality of life. Dietary changes in insomnia patients have been a concern. To explore the rationality of diet in patients with ID and its correlation with insomnia in ID patients. PATIENTS AND METHODS: This study included 216 patients diagnosed with ID and 197 individuals as the healthy control (HC) group who attended the neurology outpatient clinic or sleep clinic at Henan Provincial People’s Hospital between September 2018 and November 2019. Through the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD), sleep and mental conditions were assessed in the ID and HC groups. The dietary intake structure of both groups was observed using the food frequency table. Meanwhile, the relationship between dietary intake and sleep quality was analyzed based on the logistics regression. RESULTS: Individuals in the ID group had significantly higher age, weight, and body mass index compared to the HC group (p<0.01). Individuals within the ID category demonstrated a heightened daily consumption of carbohydrates, grains, tubers, and legumes relative to the healthy control group. In contrast, the intake levels of vegetables, fruits, and nuts were diminished compared to the HC group, with this difference being statistically significant (p<0.01). A positive correlation was observed between the daily consumption of grains, tubers, and legumes and PSQI scores. Conversely, a negative association was found between daily consumption of vegetables and fruits. CONCLUSIONS: ID patients exhibit an elevated intake of carbohydrates, whereas the consumption of vegetables, fruits, and nuts is deficient in comparison to the healthy cohort, implying that a distorted dietary structure might be a contributing factor to ID onset. Sensible and scientific dietary guidance is of considerable significance in preventing the onset of ID and facilitating its management. However, the derived conclusions warrant further extensive research. [ABSTRACT FROM AUTHOR]

Background: Insomnia disorder (ID), one of the most common psychophysiological disorders, can cause a serious burden on the individual's work and academic performance. Cognitive dysfunction often exists in patients with insomnia, which negatively affects their living quality. Inhibitory control (IC), as a vital cognitive function, allows individuals to suppress attention, behavior, or thoughts that are irrelevant to the task, so as to effectively adapt to the current goal. The earlier studies on the inhibitory control of insomnia patients predominantly used subjective scales for evaluation and that can have drawbacks because they don't provide an objective assessment. Methods: In order to investigate the inhibitory control function of insomniacs, this research subdivides inhibitory control into response inhibition and conflict inhibition. The response inhibition and conflict inhibition capacities of insomniacs were evaluated using the two-choice oddball task and the color-word stroop task, and accordingly the association between insomnia disorder and inhibitory control capacity as well as its cognitive neural mechanism was able to be examined. Results: Behavioral results finding, insomniacs conducted the two-choice oddball test and the color-word stroop task with lower accuracy and slower reaction times when compared to healthy sleepers. ERP results finding, when performing the two-choice oddball task, the P3 amplitude of the insomniacs was significantly lower than that of healthy sleepers while there was no significant difference between the two groups' N2 amplitudes. At the same time, when completing the color-word stroop task, the insomniacs' N450 amplitude was significantly lower than that of healthy sleepers. Discussion: The above findings suggest that in response inhibition tasks, insomniacs may have weaker motor inhibition abilities, and similarly perform weaker conflictmonitoring abilities in conflict inhibition tasks, which indicates that insomniacs' inhibitory control is impaired compared to that of healthy sleepers. This study thus relates to the finding at the electrophysiological level that there is a certain correlation between insomnia and a decline in inhibitory control ability, which may suggest that improving inhibitory control function in patients with insomnia is a clinically significant and worthwhile area of adjuvant treatment. [ABSTRACT FROM AUTHOR]

Background: Insomnia disorder (ID) seriously affects people's daily life. Difficulty falling asleep is the most commonly reported complaint in patients with ID. However, the mechanism of prolonged sleep latency (SL) is still obscure. The aim of our present study was to investigate the relationship between prolonged SL and alterations in spontaneous neural activity and brain functional connectivity (FC) in ID patients using functional magnetic resonance imaging (fMRI). Methods: A total of 52 insomniacs with difficulty falling asleep and 30 matched healthy controls (HCs) underwent resting-state fMRI. The amplitude of low-frequency fluctuation (ALFF) was measured and group differences were compared. The peak areas with significantly different ALFF values were identified as the seed regions to calculate FC to the whole brain. SL was assessed by a wrist actigraphy device in ID patients. The Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA), and Hyperarousal Scale (HAS) were evaluated in both ID patients and HCs. Finally, correlation analyses were performed between the clinical features and FC/ALFF values. Results: ID patients showed higher PSQI, HAMA, HAS scores than HCs. The functional MRI results indicated increased ALFF value in the left insula and right amygdala and decreased ALFF value in the right superior parietal lobe (SPL) in ID patients. The seed-based FC analysis demonstrated increased FC between the left insula and the bilateral precentral gyrus and FC between the right amygdala and the left posterior cingulate cortex (PCC) in patients with ID. Correlation analysis indicated that the increased FC value of the right amygdala-left PCC was positively correlated with SL measured by actigraphy. Conclusion: This study revealed abnormal regional spontaneous fluctuations in the right amygdala, left insula, and right SPL, as well as increased FC in the left insula-precentral and right amygdala-left PCC. Moreover, the prolonged SL was positively correlated with the abnormal FC in the right amygdala-left PCC in ID patients. The current study showed the correlation between prolonged SL and the abnormal function of emotion-related brain regions in ID patients, which may contribute to a better understanding of the neural mechanisms underlying difficulty falling asleep in patients with ID. Clinical Trial Registration: http://www.chictr.org.cn., ChiCTR1800015282. Registered on 20th March 2018. [ABSTRACT FROM AUTHOR]

Summary: Cognitive behavioural therapy for insomnia (CBT‐I) is considered the front‐line treatment for insomnia. Despite the demonstrated effectiveness of CBT‐I, it is necessary to consider how CBT‐I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT‐I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT‐I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT‐I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT‐I to specific individuals via case‐formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT‐I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT‐I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT‐I and evaluate the benefits of these adaptations. [ABSTRACT FROM AUTHOR]

Summary: Insomnia is a common disorder and cognitive behavioural therapy for insomnia (CBT‐I) is recommended as first‐line treatment. However, CBT‐I is not widely distributed and infrequently available while medication is not indicated for long‐term use. To close this evident gap in supply, alternative treatments could be utilised. High‐quality research on this topic is scarce, and there is currently no comprehensive publication on the effectiveness of alternative treatments. To address this pressing question, we systematically summarised the existing research on alternative treatments for insomnia. A comprehensive search of systematic reviews and (network) meta‐analyses of randomised controlled trials investigating the efficacy of alternative treatments compared to waiting‐list control or placebo in adults with insomnia disorder with or without comorbidities was conducted in PubMed, MEDLINE, PsycInfo, and PsycArticles on December 6, 2022, yielding 391 records. Finally, 15 eligible studies were included. Evidence on acupuncture, exogenous melatonin, mind–body interventions and exercise, repetitive transcranial magnetic stimulation (rTMS), valerian, and light exposure was found. Acupuncture, rTMS and mind–body exercises significantly improved sleep quality and insomnia severity but effects on objectively assessed outcomes were inconclusive. Melatonin led to a reduction in both self‐reported and objectively assessed sleep onset latency. Light exposure and valerian did not significantly improve sleep outcomes. Overall, the quality of studies was rated as low. Results indicate that alternative treatments are effective mostly on subjective outcomes. However, evidence on the efficacy of some intervention types is sparse and there is a need for high‐quality original studies. Future research could investigate whether combining different alternative treatment aspects with CBT‐I improves individual treatment. [ABSTRACT FROM AUTHOR]