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Purpose: Antarctic expeditions are exceptional physiological challenges. Sleep plays a critical role in athletic performance, recovery, and wellness, with sleep disturbances having a negative impact on health and performance. Methods: The authors investigated sleep, fatigue, and recovery profiles of the longest solo unsupported one-way polar ski journey across Antarctica. A 33-year-old woman covered 1484.53 km from Hercules Inlet to the South Pole, finishing at the Ross Ice Shelf, in 70 days and 16 hours. Questionnaires on sleep (Pittsburgh Insomnia Rating Scale and Karolinska Sleepiness Scale), fatigue (Subjective Assessment of Fatigue), recovery (Total Quality Recovery), and wellness were completed at different time points (before, during, and after the expedition). Results: Average daily sleep time was between 4 and 5 hours, increasing to 7 hours for the final part of the expedition. Satisfaction of sleep and lack of energy deteriorated as the expedition progressed, alongside signs of clinical insomnia. Fatigue and muscle soreness increased with increasing milage, with extreme levels and very poor recovery toward the end of the expedition. Despite this, the adventurer continued to perform on extremely high levels. Postexpedition scores returned to baseline, demonstrating the incredible adaptation and ability to recovery. The postexpedition interview showed that prior experience of an Antarctic expedition may have prepared the athlete and made her more resilient for this challenge. Conclusions: The data provide unique insights into Antarctic expeditions and may help us understand the limits of human performance when planning future expeditions of this nature. Female athletes are capable of extreme challenges, breaking established performance boundaries. [ABSTRACT FROM AUTHOR]

Study objectivesInsomnia symptoms are prevalent along the trajectory of Alzheimer's disease (AD), but the neurobiological underpinning of their interaction is poorly understood. Here, we assessed structural and functional brain measures within and between the default mode network (DMN), salience network, and central executive network (CEN).MethodsWe selected 320 participants from the ADNI database and divided them by their diagnosis: cognitively normal (CN), Mild Cognitive Impairment (MCI), and AD, with and without self-reported insomnia symptoms. We measured the gray matter volume (GMV), structural covariance (SC), degrees centrality (DC), and functional connectivity (FC), testing the effect and interaction of insomnia symptoms and diagnosis on each index. Subsequently, we performed a within-group linear regression across each network and ROI. Finally, we correlated observed abnormalities with changes in cognitive and affective scores.ResultsInsomnia symptoms were associated with FC alterations across all groups. The AD group also demonstrated an interaction between insomnia and diagnosis. Within-group analyses revealed that in CN and MCI, insomnia symptoms were characterized by within-network hyperconnectivity, while in AD, within- and between-network hypoconnectivity was ubiquitous. SC and GMV alterations were nonsignificant in the presence of insomnia symptoms, and DC indices only showed network-level alterations in the CEN of AD individuals. Abnormal FC within and between DMN and CEN hubs was additionally associated with reduced cognitive function across all groups, and increased depressive symptoms in AD.ConclusionsWe conclude that patients with clinical AD present with a unique pattern of insomnia-related functional alterations, highlighting the profound interaction between both conditions.

Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans. Using data from a comparative effectiveness clinical trial of two insomnia behavioural treatments (both including sleep restriction, stimulus control, and sleep hygiene education), we examined the impact of pain severity and pain interference on sleep improvements from baseline to post-treatment and 3-month follow-up. We found no significant moderation effects of pain severity or interference in the relationship between treatment phase and sleep outcomes. Findings highlight opportunities for using behavioural sleep interventions in patients, particularly women veterans, with comorbid pain and insomnia, and highlight areas for future research.

BACKGROUND: Pharmacologic treatments are available to treat insomnia, a common and burdensome sleep disorder, but may be contraindicated in older adults who are prone to side effects from sleep-promoting drugs. These analyses of sleep diary data from Study E2006-G000-303 (Study 303) investigated the benefits of lemborexant 5 mg (LEM5) and 10 mg (LEM10) in the subgroup age ≥ 65 years with insomnia. METHOD: Study 303, a 12-month, double-blind study of LEM5 and LEM10 in adults (age ≥ 18 years) with insomnia disorder (sleep onset and/or maintenance difficulties) assessed subject-reported (subjective) sleep-onset latency (sSOL), sleep efficiency (sSE), wake after sleep onset (sWASO), and total sleep time (sTST). Morning sleepiness/alertness, insomnia severity (Insomnia Severity Index [ISI]), fatigue (Fatigue Severity Scale [FSS]), perceptions of sleep-related medication effects (Patient Global Impression-Insomnia [PGI-I] questionnaire), and safety were also evaluated. RESULTS: In this subgroup of older adults (≥ 65 years; n = 262), there were significantly larger changes from baseline for sSOL, sSE, sTST, and sWASO with LEM5 and LEM10 versus placebo through month 6 (except sWASO month 1), indicating improvement; these improvements were sustained through month 12. Subject-reported increases in morning alertness were significantly greater with one or both LEM doses versus placebo through month 6 and sustained through month 12. There were significantly larger ISI total and daytime functioning score decreases (improvement) from baseline with LEM versus placebo at months 1, 3, and 6 (total score: both doses; daytime functioning: LEM5 month 1 and both doses months 3 and 6) and decreases from baseline FSS at months 1 and 3 (LEM5) and month 6 (both doses), sustained to month 12. Compared with placebo, more subjects reported that LEM (both doses) positively impacted ability to sleep, time to fall asleep, and TST through month 6, sustained to month 12, with no rebound after drug withdrawal. LEM was well tolerated to month 12; mild somnolence was the most common treatment-emergent adverse event. CONCLUSIONS: Improvements in subject-reported efficacy in LEM-treated adults age ≥ 65 years with insomnia were observed as early as the first week of treatment and sustained through end of month 12. LEM was well tolerated. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT02952820: E2006-G000-303; Study 303; SUNRISE-2 (First posted: October 2016); EudraCT 2015-001463-39 (First posted: November 2016).

Background and aimsThe precise roles of screen media activity (SMA) and sleep problems in relation to child/adolescent psychopathology remain ambiguous. We investigated temporal relationships among sleep problems, SMA, and psychopathology and potential involvement of thalamus-prefrontal-cortex (PFC)-brainstem structural covariation.MethodsThis study utilized data from the Adolescent Brain Cognitive Development study (n = 4,641 ages 9-12) at baseline, Year1, and Year2 follow-up. Cross-Lagged Panel Models (CLPMs) investigated reciprocal predictive relationships between sleep duration/problems, SMA, and psychopathology symptoms. A potential mediating role of baseline Thalamus-PFC-brainstem covariation on SMA-externalizing relationships was examined.ResultsParticipants were divided into discovery (n = 2,359, 1,054 girls) and replication (n = 2,282, 997 girls) sets. CLPMs showed 1) bidirectional associations between sleep duration and SMA in late childhood, with higher frequency SMA predicting shorter sleep duration (β = -0.10 [95%CI: -0.16, -0.03], p = 0.004) and vice versa (β = -0.11 [95%CI: -0.18, -0.05], p < 0.001); 2) externalizing symptoms at age 10-11 predicting sleep problems (β = 0.11 [95%CI: 0.04, 0.19], p = 0.002), SMA (β = 0.07 [95%CI: 0.01, 0.13], p = 0.014), and internalizing symptoms (β = 0.09 [95%CI: 0.05, 0.13], p < 0.001) at age 11-12; and 3) externalizing behavior at age 10-11 partially mediating the relationship between baseline thalamus-PFC-brainstem covariation and SMA at age 11-12 (indirect effect = 0.032 [95%CI: 0.003, 0.067], p-value = 0.030). Findings were replicable.ConclusionWe found bi-directional SMA-sleep-duration associations in late childhood. Externalizing symptoms preceded future SMA and sleep disturbances and partially mediated relationships between structural brain covariation and SMA. The findings emphasize the need for understanding individual differences and developing and implementing integrated strategies addressing both sleep concerns and screen time to mitigate potential impacts on psychopathology.

Study objectivesThis study was conducted to determine (1) whether the distribution of undergraduates who endorse insomnia or behaviorally induced insufficient sleep syndrome (BIISS) varied during the coronavirus disease 2019 (COVID-19) pandemic relative to normal sleepers and in comparison to values reported pre-pandemic and (2) whether group (insomnia, BIISS, and normal sleepers) was differentially associated with health, stress, and academic achievement mid-pandemic.MethodsTwo hundred ninety-three undergraduates completed online questionnaires assessing demographics, global sleep quality, insomnia severity, health, and perceived stress; cumulative grade point averages (GPAs) were also collected for each participant.ResultsThe proportion of participants in each group did not differ from the pre-pandemic values reported in Williams et al (2020). Relative to the normal-sleepers group, the insomnia group reported poorer sleep quality, greater insomnia severity, poorer functioning on measures of physical health, and increased stress; only 1 significant difference was found concerning the BIISS group. Group differences were not found on GPA.ConclusionsDespite the various challenges brought about by the COVID-19 pandemic, the distribution of participants by group was similar to those reported pre-pandemic. The insomnia group fared most poorly in terms of sleep quality, insomnia severity, physical health, and stress. As such, additional effort should be devoted to identifying undergraduates with insomnia to provide treatment that may improve their sleep and their health.CitationLukowski AF, Kamliot DZ, Schlaupitz CA. Insomnia and behaviorally induced sleep syndrome in undergraduates tested during the COVID-19 pandemic: associations with health, stress, and GPA. J Clin Sleep Med. 2024;20(2):261-269.

INTRODUCTION: This study examined the prevalence and correlates of probable mental health disorders, including psychological distress, somatization, depression, anxiety, phobic anxiety (PHO), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and insomnia among Chinese primary health care (PHC) physicians and nurses amid the post-pandemic period in 2022. METHOD: Region-stratified sampling was conducted to recruit a national sample of 4,246 respondents from 31 July 2022 to 12 August 2022. A total of 692 primary healthcare institutions were identified in 30 provincial-level administrative regions of China. An online questionnaire was used for assessing probable mental health disorders using Symptoms Checklist-90-Revised (SCL-90-R) and PTSD Checklist for DSM-5 (PCL-5), and sleeping problems using Insomnia Severity Index (ISI). Data on demographics and work were also collected. Bivariate analysis and multiple logistic regression were conducted to identify significant correlates of probable mental health disorders. RESULTS: A total of 4,246 valid questionnaires were identified. Results showed that relative to the prevalence of probable mental health disorders among health care workers at the early stage of the pandemic in China, there was an overall decreased prevalence except for somatization, PHO, and OCD among the current PHC physicians and nurses. Multiple logistic regressions showed that significant risk factors of common probable mental health disorders, namely psychological distress, SOM, DEP, ANX, PHO, OCD, PTSD, and insomnia, were female gender, multimorbidity, history of psychiatric disorders, quarantine experience, never asking anyone for help, and overtime work. CONCLUSION: Attention should be given to preexisting psychiatric and multimorbid conditions, social support, and work-related stressors. Regular assessment and psychological interventions are needed to enhance the mental health of PHC professionals even after public health crisis.

OBJECTIVE: Poor sleep is associated with increased inflammation, thereby increasing the risk of chronic diseases and mortality. However, the effects of behavioral sleep interventions on the upstream inflammatory system are unknown among family care partners (CP). The present study explored the role of a behavioral sleep intervention program on inflammatory gene expression. METHODS: This was part of a randomized controlled trial of a sleep intervention for dementia care dyads with sleep problems. Thirty dyads were randomized to sleep intervention or control groups. Sleep outcomes for CP were assessed with 1 week of actigraphy and sleep diary, and the Pittsburgh Sleep Quality Index. Other information included CP demographics, body mass index, and intensity of caregiving tasks. All outcomes were collected at baseline, post-treatment, and 3-month follow-up. RESULTS: Neither group showed any significant differential changes in gene expression from baseline to post-treatment or 3-month follow-up. A decrease in inflammatory gene expression was significantly associated with more nights of good sleep (i.e. nights without trouble falling or staying asleep at night). This finding remained significant after controlling for group (intervention/control), timepoint (baseline, post-treatment, and 3-month follow-up), and CP characteristics (e.g. age and ethnicity). CONCLUSIONS: Although better sleep was associated with decreased inflammatory gene expression, this study did not demonstrate any benefits of a behavioral sleep intervention over control, most likely due to a small sample. Studies with larger sample sizes are needed to test the specific aspects of disturbed sleep that relate to inflammatory biology among CP of persons living with dementia.

STUDY OBJECTIVES: Sleep loss contributes to various health issues and impairs neurological function. Molecular hydrogen has recently gained popularity as a nontoxic ergogenic and health promoter. The effect of molecular hydrogen on sleep and sleep-related neural systems remains unexplored. This study investigates the impact of hydrogen-rich water (HRW) on sleep behavior and neuronal activation in sleep-deprived mice. METHODS: Adult C57BL/6J mice were implanted with electroencephalography (EEG) and electromyography (EMG) recording electrodes and given HRW (0.7-1.4 mM) or regular water for 7 days ad libitum. Sleep-wake cycles were recorded under baseline conditions and after acute sleep loss. Neuronal activation in sleep- and wake-related regions was assessed using cFos immunostaining. RESULTS: HRW increased sleep consolidation in undisturbed mice and increased non-rapid-eye movement and rapid-eye-movement sleep amount in sleep-deprived mice. HRW also decreased the average amount of time for mice to fall asleep after light onset. Neuronal activation in the lateral septum, medial septum, ventrolateral preoptic area, and median preoptic area was significantly altered in all mice treated with HRW. CONCLUSIONS: HRW improves sleep consolidation and increases neuronal activation in sleep-related brain regions. It may serve as a simple, effective treatment to improve recovery after sleep loss.

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

Background: Men who have sex with men studying in universities (MSM-US) frequently face multiple sexual minority stressors that potentially lead to maladaptive emotional regulations and mental problems. This study compared the prevalence of depression/insomnia between MSM-US and non-MSM male university students (NUS) and hypothesized that the potential differences would be mediated via emotional dysregulation styles (rumination and catastrophizing). Methods: The study design was a cross-sectional study. NUS were recruited from a university-based survey using cluster sampling in three universities in China from June to October 2018, while MSM-US from the same university-based survey and the other community-based survey using convenience sampling. The effective samples size was 2,531 (292 MSM-US and 2,239 NUS). Structural equation modeling (SEM) was performed. Results: MSM-US had significantly higher prevalence of both probable depression (55.1% versus 35.7%; OR = 4.85, 95% CI: 3.38–6.94) and moderate-to-severe clinical insomnia (17.3% versus 4.1%; OR = 2.21, 95% CI: 1.73–2.83) than NUS. MSM-US were also more likely than NUS to use emotional dysregulation styles (rumination/catastrophizing), which were correlated with probable depression/insomnia (r = 0.17 to 0.31). In the SEM, the differences in depression/insomnia between MSM-US and NUS were partially mediated by the latent variable of emotional dysregulation (rumination and catastrophizing), with effect sizes of 55.0% for probable depression and 33.6% for insomnia, respectively. Conclusions: Depression and insomnia were prevalent among male university students in Sichuan, China. Furthermore, MSM-US were at increased risk than NUS for both mental problems; emotional dysregulation partially explained such differences. Future studies are warranted to confirm the findings, develop tailored interventions to address general and MSM-specific stressors and reduce rumination and catastrophizing, and examine whether similar patterns exist in other sexual minority groups. [ABSTRACT FROM AUTHOR]

Background: Both night-eating syndrome and binge-eating disorder are characterized by episodes of excessive food consumption, significant distress, and functional impairment related to maladaptive eating behaviors. Both types of eating disorders are associated with poorer sleep quality. Cognitive behavioral therapy has demonstrated good outcomes for binge-eating disorder; however, it is unknown if it is effective for night-eating syndrome and comorbid insomnia. Case presentation: The current paper presents a case report of a Dutch woman in her 40's receiving cognitive behavioral therapy-enhanced for night-eating syndrome, as well as binge-eating disorder. However, to tailor the intervention to her specific needs, throughout the course of treatment, cognitive behavioral therapy-insomnia interventions were also implemented. Her comorbid complaints were insomnia, childhood trauma, a depressive mood disorder, and cluster B and C personality traits. She had a history of bariatric surgery, as well as alcohol addiction, and received various treatments in the past, aiming to become abstinent from binge eating. Conclusions: Post-treatment, she was abstinent from binge eating and, her scores of various eating disorder measures were below clinical cut-points. However, it is unclear if she would show earlier symptom reduction if she received cognitive behavioral therapy-insomnia, prior to cognitive behavioral therapy-enhanced. In addition, the patient reported an increase in her depressive mood and commenced schema therapy after cognitive behavioral therapy- enhanced. Although common, the underlying cause of symptom shifts in patients with an eating disorder remains largely unknown. [ABSTRACT FROM AUTHOR]

Background: Limitations of conventional treatment methods for sleep disorders have driven the use and development of complementary and alternative therapies such as acupuncture. However, despite the surge in related studies, there is still a lack of visual analysis and detailed elaboration regarding the current status, international collaborations, and research hotspots of acupuncture for sleep disorders. Methods: We conducted a bibliometric analysis of publications on acupuncture for sleep disorders using the Web of Science Core Collection database from 2004 to 2023. We utilized the R package "bibliometrix" to count publications and citations, VOSviewer to create an inter-institutional referencing network, and CiteSpace to identify references and keywords with the highest citation bursts. Additionally, we employed a bibliometric online analysis platform designed for analyzing national partnerships. Results: A total of 432 pertinent papers were retrieved, with China being the most prolific contributor, accounting for 61.6% of the publications, followed by the United States and South Korea. Despite China's high output, its average article citation rate and proportion of international collaborations were notably lower than those of the United States. Key research institutions such as the University of Hong Kong, Shanghai University of Traditional Chinese Medicine, Memorial Sloan Kettering Cancer Center, and Guangzhou University of Chinese Medicine have played significant roles in this field. Among authors, Ka-Fai Chung from the University of Hong Kong stood out as the most productive. In terms of journals, MEDICINE was the most active, while SLEEP was considered the most authoritative. The clinical effects of acupuncture for insomnia have garnered significant attention in recent years, with electroacupuncture emerging as the prevailing technique for addressing sleep disorders. Conclusion: This bibliometric study effectively outlines the basic framework of knowledge surrounding acupuncture for sleep disorders over the past two decades, covering publications, countries, institutions, authors, and sources. It highlights promising clinical effects and underlying mechanisms of acupuncture, particularly for secondary insomnia and specific sleep disorders like restless legs syndrome. Moving forward, the focus and challenge for future research lie in the development of standardized study protocols and harmonization of efficacy assessment metrics. [ABSTRACT FROM AUTHOR]

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

Introduction: Insomnia is associated with mild cognitive impairment, although the mechanisms of this impairment are not well-understood. Timing of slow-wave and rapid eye movement sleep may help explain cognitive impairments common in insomnia. This investigation aimed to determine whether cognitive changes following continuous theta-burst stimulation (cTBS) are attributable to active stimulation, polysomnographic parameters of sleep, or both. Method: Data presented here are part of a pilot clinical trial aiming to treat insomnia by targeting a node in the default mode network using an inhibitory 40-s (cTBS). A double-blind counterbalanced sham-controlled crossover design was conducted. Participants (N = 20) served as their own controls on two separate in-laboratory visits—one with active cTBS and the other with sham cTBS. Each visit included cognitive assessments before and after stimulation and following a night of sleep in the lab monitored with polysomnography. Results: Slow wave sleep duration influenced working memory in the active cTBS condition, with shorter duration predicting improvements in working memory post sleep (B = −0.003, p = 0.095). Onset latency to rapid eye movement sleep predicted subsequent working memory, regardless of treatment condition (B = −0.001, p = 0.040). Results suggest that changes in attention and processing speed were primarily due to slow wave sleep onset (B = −0.001, p = 0.017) and marginally predicted by slow wave sleep duration (B = 0.002, p = 0.081) and sleep efficiency (B = 0.006, p = 0.090). Conclusions: Findings emphasize the important role that timing of slow-wave and rapid eye movement sleep have on information processing. Future work using larger sample sizes and more stimulation sessions is needed to determine optimal interactions between timing and duration of slow wave and rapid eye movement throughout the sleep period. Clinical trial registration: This study is registered on ClinicalTrials.gov (NCT04953559). https://clinicaltrials.gov/study/NCT04953559?locStr=Arizona&country=United%20States&state=Arizona&cond=insomnia&intr=tms%20&rank=1 [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) and insomnia are common global health issues, but their relationship and potential mediators remain unclear. This study aimed to explore the impact of insomnia on LBP using mendelian randomization (MR) methods and analyze the mediating role of modifiable factors. Methods: Univariable MR (UVMR) analysis was employed to examine the causal relationship between insomnia and LBP, as well as the association between modifiable factors [smoking, alcohol consumption, body mass index (BMI), and type 2 diabetes (T2DM)] and LBP. Subsequently, multivariable MR (MVMR) analysis was conducted to explore the impact of insomnia on the mediation of LBP risk by modifiable factors. Results: In the UVMR analysis, insomnia [odds ratio (OR) = 2.95, 95%CI: 2.33–3.72)] and BMI (OR = 1.18, 95%CI: 1.02–1.37) were positively associated with the prevalence of LBP. The effects of smoking, alcohol consumption, and T2DM on LBP were not significant (P > 0.05). In the MVMR analysis, the proportion of mediation of BMI on the relationship between insomnia and LBP was 7.12%. Conclusion: This study revealed the causal relationship between insomnia and LBP using MR methods for the first time, and identified the mediating role of BMI. These findings offer new insights into understanding the relationship between insomnia and LBP, informing the prevention and treatment of these two health issues. [ABSTRACT FROM AUTHOR]

Summary Insomnia has been suggested as a potential modulator of systemic inflammation. However, few studies have examined the longitudinal association between insomnia and inflammation as well as the role of sex differences, despite accumulating evidence of the vulnerability of women to immune consequences of disturbed sleep. In this study, we tested the association between self‐reported insomnia symptoms and serum C‐reactive protein, a marker of systemic inflammation, at 1‐year follow‐up, in 54 outpatients with inflammatory bowel disease (52.81 ± 16.09, 40.7% women). Insomnia symptoms were measured using the Insomnia Severity Index. After controlling for baseline inflammation and health variables, longitudinal moderated regression analysis showed that baseline insomnia symptoms predicted C‐reactive protein levels at follow‐up in women (β = 0.416, p = 0.014), but not in men (β = −0.179, p = 0.212). Results were not influenced by sex differences in insomnia severity or C‐reactive protein levels. This study suggests insomnia symptoms may partially influence systemic inflammation in women with inflammatory bowel disease. Sex‐specific psychological, immune and neuroendocrine pathways linking sleep to inflammation should be further elucidated. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and sociodemographic profiles of mental morbidity and multimorbidity. Methods: A descriptive analysis was performed with data from 25,269 women and 8,389 men from the French NutriNet-Santé general-population cohort. Participants were split into 8 groups: 1. No mental morbidity; 2. Pure anxiety; 3. Pure insomnia; 4. Pure eating disorders (ED); 5. Comorbid anxiety and insomnia; 6. Comorbid anxiety and ED; 7. Comorbid insomnia and ED; 8. Multimorbid anxiety, insomnia, and ED. Data were weighted using the 2016 French Census and analyzed with Chi2 tests. Results: 40.6% of the participants had ≥1 mental disorder; 2.3% had all 3 disorders. Most pure and comorbid disorders were more common in women than in men. The multimorbidity group had the largest proportions of men who were overweight (52.1%) and current smokers (23.2%). Men with insomnia and ED were the most likely to have obesity (45.8%) and low physical activity (44.3%). Women with ≥2 disorders were the most likely to be current smokers. Conclusion: The findings could inform research, prevention, and public health guidelines for multimorbidity. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents' health and well-being are seriously threatened by suicidal behaviors, which have become a severe social issue worldwide. Suicide is one of the leading causes of mortality for adolescents in low and middle-income countries, with approximately 67,000 teenagers committing suicide yearly. Although an association between sleep disturbances (SDs) and suicidal behaviors has been suggested, data are still scattered and inconclusive. Therefore, to further investigate this association, we conducted a meta-analysis to verify if there is a link between SDs and suicidal behaviors in adolescents without diagnosed psychiatric disorders. Methods: PubMed, CENTRAL, EMBASE, and PsycINFO were searched from inception to August 30th, 2024. We included studies reporting the estimation of suicidal behaviors in adolescents from 12 to 21 years of age, with SDs and healthy controls. The meta-analysis was based on odds ratio (OR, with a 95% confidence interval ([CI]), estimates through inverse variance models with random-effects. Results: The final selection consisted of 19 eligible studies from 9 countries, corresponding to 628,525 adolescents with SDs and 567,746 controls. We found that adolescents with SDs are more likely to attempt suicide (OR: 3.10; [95% CI: 2.43; 3.95]) and experience suicidal ideation (OR: 2.28; [95% CI 1.76; 2.94]) than controls. Conclusion: This meta-analysis suggests that SDs are an important risk factor for suicidal ideation and suicide attempts in healthy adolescents. The findings highlight the importance of early identification of SDs to prevent suicidal behaviors in this population. Systematic review registration: PROSPERO, identifier CRD42023415526. [ABSTRACT FROM AUTHOR]

Introduction: The present study examined the moderating effects of sleep quality in the relationship between coping and distress among medical college students. Present study was conducted to ensure the mental health of medical students and to dig out the reasons behind their disturbed health which can directly impact their performance at work. Methods: The study utilized a cross-sectional survey and was distributed to students at various medical institutions in the Punjab province of Pakistan from October 2019 to June 2020. The sample comprised 369 participants (120 males; 32.5%). The survey included the Pittsburgh Sleep Quality Index (PSQI), Kessler Scale of Psychological Distress (K10), Brief Cope Scale, and Wong and Law Emotional Intelligence Scale. Results: The results showed there was a significant relationship between coping and distress. More specifically, adaptive coping and distress were negatively associated (r =-.24), and maladaptive coping and distress were positively associated (r =.46). Moreover, the present study found that poor sleep quality was a significant positive predictor of distress. Moderation analysis showed that sleep quality was a significant moderator in the relationship between adaptive coping and distress (ΔR2=.011, β=-.36, p <.01) as well as between maladaptive coping and distress (ΔR2=.021, β=-.17, p <.01). Conclusion: The study's findings clearly showed that sleep quality is a significant moderator in the relationship between coping (both adaptive and maladaptive) and distress among medical students. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Insomnia is a common sleep disorders that affects most individuals in the United States, and worldwide. Insomnia is linked with an increased risk of atrial fibrillation (AF) in adults, although the strengths of association were weak, especially in the elderly population. AF is estimated to affect approximately 3 to 6 million people in the United States. We studied the association of AF with insomnia in the elderly population. Methods: We reviewed the electronic medical records of elderly patients who received care in an internal medicine office from July 1, 2020 through June 30, 2021. Patients were grouped into AF group, and a group without AF (NOAF). Association of insomnia and other variables were compared between the 2 groups. Results: Among 2428 patients, 341 (14%) had AF. Patients in the AF group were significantly older compared to no-AF group (80.3 ± 7.9 vs 76.1 ± 7.4 years; P <.001). A higher frequency of men was noted in AF group versus NOAF group (54.3 vs 42.0%; P <.001). The frequency of insomnia was significantly higher in AF group versus NOAF group (14.1 vs 9.5%; P <.05). Additionally, greater frequencies of associations of other comorbid medical conditions were noted in the AF group compared to NOAF group, such as cerebrovascular accident (CVA; 12.9 vs 5.4%; P <.001), transient ischemic attack (TIA; 7.0 vs 3.0%; P <.001), dementia (5.9 vs 3.3%; P <.05), coronary artery disease (CAD; 34.9 vs 18.3%; P <.001), congestive heart failure (CHF; 21.1 vs 3.8%; P <.001), other cardiac arrhythmias (53.4 vs 6.3%; P <.001), chronic obstructive pulmonary disease (COPD; 12.3 vs 5.7%; P <.001), obstructive sleep apnea (OSA; 17.6 vs 11.8%; P =.003), chronic kidney disease (CKD; 22.9 vs 11.9%; P <.001), anemia (23.2 vs 13.0%; P <.001), and cancer (36.1 vs 27.9%; P =.002). There was significantly greater odds of AF in patients who had insomnia (OR = 1.972, CI = 1.360-2.851; P <.001). Conclusion: AF was associated with insomnia in the elderly population. Higher frequencies of association of AF were also seen with older age, male sex, White race, CVA, TIA, dementia, CAD, CHF, other cardiac arrhythmias, COPD, OSA, CKD, anemia, and cancer. [ABSTRACT FROM AUTHOR]

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

Background: Weighted blanket is an emerging non-pharmacotherapy for sleep disorders, but its effect on sleep among relatively healthy adults with insomnia remains uncertain. This study aimed to evaluate whether weighted blankets could better improve sleep quality and sleep-related symptoms among adults with insomnia. Methods: In a prospective, pilot randomized controlled trial conducted in three tertiary hospitals in China, participants with clinical insomnia were randomized (1:1) to receive weighted blanket intervention or normal blanket intervention for 1 month by random-number tables. The primary outcomes were sleep quality assessed with Pittsburgh Sleep Quality Index (PSQI) and insomnia severity assessed with Insomnia Severity Index. Subjective outcomes were measured at baseline, 1 week, and 1-month post-intervention. Sleep was also objectively monitored by actigraphy. We did analysis by intention to treat. Results: A total of 102 participants were randomly assigned to receive weighted blanket intervention (n = 52) or normal blanket intervention (n = 50). 95 (93.1%) participants completed the follow-up, and 7 (6.9%) participants dropped out of the study. The weighted blanket group had significant improvements in sleep quality compared to the normal blanket group after 1 month of intervention (changes in the mean [SD] of PSQI score: -4.1 [4.1] vs. -2.0 [3.2], P = 0.006). Similar results were observed for daytime sleepiness, stress, anxiety, fatigue, and bodily pain (all P < 0.05). Recordings from actigraphy showed a decrease in the mean (SD) of the number of awakenings in weighted blanket group (-1.4 [9.5]) and an increase in normal blanket group (+ 1.0 [7.9]) (P = 0.280). No severe adverse events occurred. Conclusions: Weighted blanket might be an effective, safe and promising non-pharmacotherapy tool for improving sleep-related symptoms among adults with insomnia, although validation with a larger sample size is needed. Trial registration: Chinese Clinical Trial Registry: ChiCTR2300078011, date of registration: 11/27/2023, retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: This study aims to elucidate characteristics of the symptom network of work–family conflict (WFC) and sleep disorders among Chinese correctional personnels while accounting for job burnout as a possible confounder. Method: A total of 472 correctional personnel were included. Their WFC, sleep disorders, and job burnout were measured using a Chinese version of Work–Family Conflict Scale (WFCS), the Athens Insomnia Scale (AIS), and a revised Chinese version of Maslach Burnout Inventory‐General Survey (MBI‐GS), respectively. Central symptoms and bridge symptoms were respectively identified based on centrality indices and bridge centrality indices. Network stability was examined using the case‐dropping procedure. Results: Daytime condition (strength = 0.01) and strain‐based work interference with family (WFCs, strength = 1.45) symptoms had the highest centrality values in the WFC‐sleep disorder network structure, which were also identified as two bridge symptoms. Emotional exhaustion, daytime condition, and WFCs appeared to be potential bridge symptoms in the WFC–sleep disorder–burnout network structure. Conclusions: In this study, among Chinese correctional personnel, daytime conditions, and WFCs were found to be central symptoms in the WFC–sleep disorder network structure, with emotional exhaustion as the bridge symptom in the WFC–sleep disorder–burnout network structure. We encourage relevant organizations to provide timely and effective education and guidance for regulatory personnel regarding these bridge symptoms. Subsequent research should follow up to assess the impact of relevant interventions on symptoms in the WFC–sleep disorder–burnout network, thereby advocating for the mental and physical health of correctional personnel. [ABSTRACT FROM AUTHOR]

Background: Insomnia symptoms that influence daytime functioning are common among adults with type 2 diabetes. However, no previous study has examined if levels of physical activity differ among adults with diabetes with and without insomnia symptoms. Thus, the aim of this study was to assess the difference in total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) levels in individuals with diabetes with and without insomnia symptoms. Methods: This cross-sectional study included 1,354 participants with any type of diabetes who participated in the Norwegian HUNT4 Study, 2017-19. Participants were defined to have 'insomnia symptoms' if they reported difficulty initiating and/or maintaining sleep ≥ 3 nights/week during the last 3 months. MVPA (defined as moderate/brisk walking [> 4.0 km/h], running, and cycling), and TPA (MVPA including slow walking [≤ 4.0 km/h]) were determined from two accelerometers worn on the thigh and lower back. Analyses were stratified by age and sex. Results: The median age was 67 years and 491 (36%) had insomnia symptoms and 37 (3%) had insomnia disorder. Among women, 28% with one or more insomnia symptoms fulfilled the recommended minimum level of physical activity, as compared to 34% in women without insomnia symptoms. The corresponding proportions in men were 48% and 45%. Women above 65 years with insomnia symptoms performed less TPA (-73 min/week, 95% CI -122 to -24) and MVPA (-33 min/week, 95% CI -50 to -15), compared to women without insomnia symptoms in the same age group. There was no clear difference in physical activity levels according to insomnia symptoms in men or women below 65 years. Women and men with insomnia disorder had substantially lower TPA (women: -192 min/week, 95% CI -278 to -106; men: -276 min/week, 95% CI -369 to -193) and MVPA (women: -37 min/week, 95% CI -63 to -11; men: -67 min/week, 95% CI -83 to -50) than those without insomnia symptoms. Conclusions: This study showed that women above 65 years with insomnia symptoms and individuals with insomnia disorder performed less physical activity, suggesting that these subgroups may suffer from additional challenges that prevent them from engaging in regular physical activity. [ABSTRACT FROM AUTHOR]

Summary Although emerging research suggests insomnia is a significant problem among people with eating disorders, little is known about how insomnia symptoms may serve as risk factors for eating disorder symptoms, treatment outcome, and relapse. University students with non‐low‐weight eating disorders (N = 89) completed a mobile guided self‐help cognitive behavioural intervention for eating disorders. Insomnia and binge‐eating symptoms were assessed at pre‐treatment and end‐of‐treatment using the Insomnia Severity Index and Eating Pathology Symptoms Inventory. Multiply imputed datasets were used to test associations between insomnia and binge eating before, during and after treatment. Insomnia was positively associated with binge‐eating symptoms prior to treatment (r = 0.47). Baseline insomnia symptoms were associated with binge‐eating symptoms at end‐of‐treatment (est = 0.269). Eating disorder treatment modestly reduced insomnia (d = −0.38); however, about half of people with clinically significant insomnia prior to treatment remained symptomatic. Insomnia symptoms and binge‐eating symptoms did not change concurrently during treatment. Overall, results support an association between insomnia and binge eating. Although eating disorder treatment may impact insomnia, many individuals remained symptomatic for sleep problems, suggesting the need for follow‐up treatments, such as cognitive behavioural therapy for insomnia, or the development of integrated insomnia–eating disorder treatments. Future studies are needed to examine causal links between insomnia and eating disorder symptoms, and test if insomnia predicts relapse after eating disorder treatment. [ABSTRACT FROM AUTHOR]

Background: Sleep and mental health problems are very common in university students. The objective of this study was to assess the effectiveness of a multi-component sleep-mood intervention on improving sleep and mental health in university students with clinically significant insomnia symptoms, and to investigate possible mediators. Methods: Thirty-five participants were randomized to the Sleep Mood Intervention: Live Effectively (SMILE) intervention (n = 23), or wait-list group (n = 12). SMILE is a multi-component group therapy and includes elements of cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and lifestyle modifications, in four weekly two-hour sessions. The primary outcome was insomnia severity. Secondary outcomes were severity of depression and anxiety, and quality of life (QoL). Dysfunctional beliefs and attitudes about sleep and pre-sleep arousal were assessed as mediators. Results: Intention-to-treat analysis showed significant time x treatment interaction on insomnia symptoms p =.02, partial η²= 0.15, d = 0.84 [95% CI: 0.63 to 1.14], with significantly lower insomnia severity for SMILE compared to waitlist at post-test. No significant effects were found on depression d = 0.02 [95% CI: -0.35 to 0.37], anxiety d = 0.15 [95% CI: -0.16 to 0.53], and QoL d = 0.09 [95% CI: -0.25 to 0.42]. Dysfunctional beliefs mediated the effect on insomnia severity, but pre-sleep arousal did not. Conclusions: This integrated group intervention is associated with reductions in insomnia symptoms in university students. Since no significant effects were detected on mood and QoL, future studies with larger sample size may explore the effects of this intervention on these outcomes. Trial registration: Registry: Overzicht van Medisch-wetenschappelijk Onderzoek. Registration number: NL-OMON46359. Date of registration: September 18th, 2018. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests a broader spectrum of celiac disease (CeD) system involvement, including neurological manifestations. We aimed to conduct a systematic review and meta-analysis of the available evidence from studies assessing the association of cognitive impairment and insomnia with CeD. A total of 259 participants with CeD were included in the studies investigating insomnia and 179 were included in studies investigating cognitive impairment. The overall pooled odds ratio for insomnia in patients with CeD was 1.83 (95% confidence interval, 1.38 to 2.42; I2 =0.00%). The present study provides valuable insights into the available evidence from studies investigating cognitive impairment in patients with CeD and our systematic review and meta-analysis revealed a significant association between CeD and insomnia. [ABSTRACT FROM AUTHOR]

Background: Insomnia commonly co‐occurs with alcohol use disorder (AUD) and predicts poorer outcomes for those with AUD. Insomnia and AUD are individually associated with increases in systemic inflammation. Insomnia and inflammation both serve as risk factors for relapse in AUD. However, little is known about the relationship between insomnia and systemic inflammation in individuals with AUD. Therefore, the present study examined the relationship between the severity of insomnia symptoms and plasma levels of inflammatory cytokines in a sample of treatment‐seeking individuals with an AUD. Methods: This secondary analysis included 101 (61M/40F) individuals with an AUD. Participants were categorized into groups based on their scores on the Insomnia Severity Index: no insomnia (n = 47), subthreshold insomnia (n = 37), and clinical insomnia (n = 17). Participants provided blood samples to measure plasma levels of four peripheral markers of inflammation (IL‐6, IL‐8, TNF‐α, and CRP). Inflammatory marker levels were compared between groups. Interactive effects of sex and AUD severity were examined. Results: There was a significant main effect of insomnia group on log IL‐8 levels (F = 6.52, p = 0.002), such that individuals with AUD and clinical insomnia had higher log IL‐8 levels compared to both the no insomnia and subthreshold insomnia groups (ps ≤ 0.05). Sex and AUD severity interacted with this relationship, such that men with clinical insomnia and AUD and individuals with severe AUD had higher log IL‐8 levels. There were no significant effects of insomnia on IL‐6, TNF‐α, or CRP levels. Conclusion: The present study identified a specific elevation in IL‐8 levels in individuals with an AUD and clinical insomnia that was not identified in other markers of peripheral inflammation (IL‐6, TNF‐α, CRP). Sex and AUD severity interacted with insomnia symptoms, indicating that those with clinical insomnia and severe AUD or male sex may be the most vulnerable to the inflammatory consequences associated with AUD and clinical insomnia symptoms. [ABSTRACT FROM AUTHOR]

In this study, we examined rates of insomnia and co-occurring unhealthy alcohol use in a national sample of women Veterans age 50 years and older. We further explored associations between sociodemographic measures, insomnia-related clinical characteristics, and unhealthy alcohol use, and analyzed whether women with insomnia were more likely to report unhealthy alcohol use. Study aims were evaluated using national Veterans Health Administration (VA) electronic health records data from VA's Corporate Data Warehouse. Data were extracted for women Veterans ≥50 years old with ≥1 VA primary care visit in each study year (2018: 3/11/18–3/10/19; 2020: 3/11/20–3/10/21; 2022: 3/11/22–3/10/23). Cases of insomnia were identified via diagnostic codes and prescription medications for insomnia. Unhealthy alcohol use was identified via Alcohol Use Disorders Identification Test-Consumption screening scores indicating unhealthy alcohol use. Annual sample sizes ranged from 240,420–302,047. Over the study timeframe, insomnia rates (diagnosis or medication) among women ≥50 years old ranged from 18.11–19.29%; co-occurring insomnia and unhealthy alcohol use rates ranged from 2.02–2.52%. Insomnia and unhealthy alcohol use rates were highest among women aged 50–59 years old. Depression and physical health comorbidities were consistently associated with insomnia; associations by race and ethnicity were less consistent. Compared to women without insomnia, women Veterans with either concurrent or unremitting insomnia were more likely to endorse unhealthy alcohol use. Findings signal a potential need for assessment and preventative efforts aimed at addressing insomnia and unhealthy alcohol use among women Veterans. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traumatic brain injury (TBI) is a hallmark of wartime injury and is related to numerous sleep wake disorders (SWD), which persist long term in veterans. Current knowledge gaps in pathophysiology have hindered advances in diagnosis and treatment. OBJECTIVE: We reviewed TBI SWD pathophysiology, comorbidities, diagnosis and treatment that have emerged over the past two decades. METHODS: We conducted a literature review of English language publications evaluating sleep disorders (obstructive sleep apnea, insomnia, hypersomnia, parasomnias, restless legs syndrome and periodic limb movement disorder) and TBI published since 2000. We excluded studies that were not specifically evaluating TBI populations. RESULTS: Highlighted areas of interest and knowledge gaps were identified in TBI pathophysiology and mechanisms of sleep disruption, a comparison of TBI SWD and post-traumatic stress disorder SWD. The role of TBI and glymphatic biomarkers and management strategies for TBI SWD will also be discussed. CONCLUSION: Our understanding of the pathophysiologic underpinnings of TBI and sleep health, particularly at the basic science level, is limited. Developing an understanding of biomarkers, neuroimaging, and mixed-methods research in comorbid TBI SWD holds the greatest promise to advance our ability to diagnose and monitor response to therapy in this vulnerable population. [ABSTRACT FROM AUTHOR]

Aims: Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non‐expert practitioners in a secondary care youth mental health service. Method: Assistant psychologists were trained to deliver a six‐session 1:1 cognitive‐behavioural sleep intervention adapted for use with young people with mental health difficulties. A within‐subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points. Results: High referral, intervention take‐up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty‐six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint. Conclusions: This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access. [ABSTRACT FROM AUTHOR]

Purpose: Sleep problems are frequently observed in cancer patients. Multiple questionnaires for assessing sleep quality have been developed. The aim of this study was to present transfer rules that allow the conversion of the patients' scores from one questionnaire to another. In addition, we anchored this common metric to the general population. Methods: A sample of 1,733 cancer patients completed the following questionnaires: Pittsburgh Sleep Quality Index, Insomnia Sleep Index, Jenkins Sleep Scale, EORTC QLQ-C30, and the sleep scale of the EORTC QLQ-SURV100. The methods for establishing a common metric were based on Item Response Theory. Results: The main result of the study is a figure that allows the conversion from one of the above-mentioned sleep scales into another. Furthermore, the scores of the questionnaires can be transferred to theta scores that indicate the position within the group of cancer patients and also to T scores that indicate the position in relation to the general population. The correlations between the sleep scales ranged between 0.70 and 0.85. Conclusions: The conversion rules presented in the study enable researchers and clinicians to directly compare single scores or mean scores across studies using different sleep scales, to assess the degree of sleep problems with regard to the general population, and to relate cutoff scores from one questionnaire to another. [ABSTRACT FROM AUTHOR]

Aim: Although the use of benzodiazepine receptor agonists is a risk factor for falls and fractures, whether benzodiazepine‐avoiding hypnotic bundles are beneficial in clinical settings remains unclear. Methods: A new hospital‐wide standardized hypnotic bundle for insomnia, with suvorexant as the first choice, was created for clinical purposes. This single‐center retrospective cohort study involved a pre‐post design and adult inpatients who had had falls. The primary outcome was the total fall rate in the pre‐post groups. Additionally, the level change in the fall‐rate trend for each month at standardization of the new hypnotic bundle was analyzed. The numbers of hypnotic‐related falls and injuries requiring treatment were evaluated. Results: There were no differences in baseline characteristics between the two groups, except for patients with COVID‐19. Overall, 31 736 patients were included in this study. The total number of falls was 924 (3.42‰) in the pre‐standardization group and 837 (3.31‰) in the post‐standardization group, with no significant difference. An interrupted time‐series analysis of the level change in the fall rate revealed that the gap in trend at standardization was –11%, with no significance. Hypnotic‐related falls were 300 (1.11‰) versus 213 (0.84‰), and the injury incidences were 251 (0.93‰) versus 181 (0.71‰) in the pre and post groups, respectively, showing a significant reduction. Conclusions: The standardization of the new hypnotic bundle for insomnia did not help achieve a significant reduction in total falls. However, our findings suggest that this bundle has the potential to reduce hypnotic‐related falls and injuries in inpatients who have had falls. Geriatr Gerontol Int 2024; 24: 1144–1149. [ABSTRACT FROM AUTHOR]

Methods: The study employed a retrospective survey of 458 older individuals with T2D residing in a Chinese community, conducted between June 2020 and May 2021, to develop a predictive model for frailty. Among the participants, 83 individuals (18.1%) were diagnosed with frailty using modified frailty phenotypic criteria. The predictors of frailty in this community‐dwelling older population with T2D were determined using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression. These predictors were utilized to construct a nomogram. The discrimination, calibration, and medical usefulness of the prediction model were assessed through the C‐index, calibration plot, and decision curve analysis (DCA), respectively. Additionally, internal validation of the prediction model was conducted using bootstrapping validation. Results: The developed nomogram for frailty prediction predominantly incorporated age, smoking status, regular exercise, depression, albumin (ALB) levels, sleep condition, HbA1c, and polypharmacy as significant predictors. Our prediction model demonstrated excellent discrimination and calibration, as evidenced by a C‐index of 0.768 (95% CI, 0.714–0.822) and strong calibration. Internal validation yielded a C‐index of 0.732, further confirming the reliability of the model. DCA indicated the utility of the nomogram in identifying frailty among the studied population. Conclusion: The development of a predictive model enables a valuable estimation of frailty among community‐dwelling older individuals with type 2 diabetes. This evidence‐based tool provides crucial guidance to community healthcare professionals in implementing timely preventive measures to mitigate the occurrence of frailty in high‐risk patients. By identifying established predictors of frailty, interventions and resources can be appropriately targeted, promoting better overall health outcomes and improved quality of life in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT‐i) is the recommended 'first line' treatment but is accessed by a minority of people with insomnia. Aims: To improve CBT‐i access in Australia, we aimed to develop and test a self‐guided interactive digital CBT‐i program. Methods: An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT‐i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ‐9), anxiety (GAD‐7), fatigue, sleepiness and maladaptive beliefs about sleep at 8‐week follow‐up. The control group accessed the intervention after the 8‐week follow‐up. Questionnaires were additionally administered at 16 and 24 weeks. Intent‐to‐treat mixed models and complete‐case chi‐squared analyses were used. Results: Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between‐group differences in baseline characteristics or missing 8‐week data (14.5%). After adjusting for baseline scores, CBT‐i was associated with lower insomnia (Diffadj (95% CI) = 7.32 (5.0–9.6), P < 0.001, d = 1.64), depression (3.36 (1.3–5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5–7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1–18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (−0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT‐i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT‐i group. Conclusions: This interactive digital CBT‐i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT‐i access and uptake. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the comparative efficacy and acceptability of cognitive behavioral therapy for insomnia (CBT‐I), pharmacotherapy, and their combination in the long and short terms among adults with chronic insomnia disorder. Methods: We searched multiple databases to December 27, 2023. We included trials in hypnotic‐free adults with chronic insomnia comparing at least two of CBT‐I, pharmacotherapy, or their combination. We assessed the confidence in evidence using CINeMA. The primary outcome was long‐term remission. Secondary outcomes included all‐cause dropout and self‐reported sleep continuity measures in the long term, and the same outcomes in the short term. We performed frequentist random‐effects network meta‐analyses (CRD42024505519). Findings: We identified 13 trials including 823 randomized participants (mean age, 47.8 years; 60% women). CBT‐I was more beneficial than pharmacotherapy in the long term (median duration, 24 weeks [range, 12 to 48 weeks]; remission odds ratio, 1.82 [95% confidence interval (CI), 1.15–2.87]; [certainty of evidence: high]), while there was weaker evidence of benefit of combination against pharmacotherapy (1.71 [95% CI, 0.88–3.30: moderate]) and no clear difference of CBT‐I against combination (1.07 [95% CI, 0.63–1.80: moderate]). CBT‐I was associated with fewer dropouts than pharmacotherapy. Short‐term outcomes favored CBT‐I over pharmacotherapy except total sleep time. Given the average long‐term remission rate in the pharmacotherapy‐initiating arms of 28%, CBT‐I resulted in a long‐term remission rate of 41% (95% CI, 31%–53%) and combination 40% (95% CI, 25%–56%). Interpretation: The current study found that starting with CBT‐I for chronic insomnia leads to better outcomes than pharmacotherapy. Combination may be better than pharmacotherapy alone, but unlikely to be worth the additional burden over CBT‐I alone. [ABSTRACT FROM AUTHOR]

Objectives: Insomnia and chronic pain are common symptoms in people with HIV. Poor sleep has been associated with chronic pain. While cognitive behavioral therapy for insomnia improves insomnia in clinical populations, there are barriers to people with HIV accessing treatment including the lack of trained providers and lengthy sessions. Only one study has examined the efficacy of brief behavioral treatment for insomnia (BBTI) in people with HIV. This study examined BBTI effects on sleep and pain in people with HIV. Methods: Ten adults with HIV and chronic pain completed a 4-week, telephone-delivered BBTI treatment. A control group (n = 10) completed a brief mindfulness training (BMT). The Insomnia Severity Index and Brief Pain Inventory were used to assess insomnia severity and pain outcomes, respectively. Results: There was a significant interaction between intervention and time on insomnia severity, F (2,14) = 5.7, p =.02, partial η2 = 0.45). The BBTI group demonstrated significant improvements in insomnia severity from pre- to post-intervention (p <.001) and from pre-intervention to one-month post-intervention (p =.001) compared to the BMT group. There was a significant interaction between intervention and time on pain interference, F (1,18) = 4.9, p =.02, partial η2 = 0.27). The BBTI group demonstrated a significant decrease in pain interference from pre- to post-intervention (p <.001) compared to the BMT group. Conclusions: This pilot study demonstrated that BBTI improved insomnia in people with HIV for up to one-month post-treatment. Novel preliminary evidence suggests that BBTI may also improve pain outcomes in people with HIV. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive Behavioral Therapy for Insomnia (CBTi) is a first-line treatment for a prevalent and impairing disorder. Digital CBTi programs increase access to internet-based self-directed care. However, the clinical effect of offering different forms of CBTi in a healthcare setting is not clearly understood. This study examines treatment engagement and clinical outcomes for individuals referred to either digital or provider-led CBTi. Methods: Over two years, providers at a Veterans Health Administration (VHA) facility referred patients to digital CBTi with telephone coaching support or traditional provider-led CBTi. Characteristics of those referred, proportions engaging in and completing treatment, as well as insomnia severity were compared among those referred to each format. Results: Providers referred 139 individuals to digital CBTi, 340 to provider-led CBTi, and 14 to both formats. Individuals referred to digital CBTi were older with less severe insomnia. Despite lower levels of program engagement and completion in the digital CBTi cohort, measures of insomnia symptom change were similar between the groups. Conclusions: This is the first study to evaluate both digital and provider-led evidence-based treatments for insomnia disorder simultaneously deployed in a healthcare setting. While engagement in digital CBTi lagged that for provider-led CBTi, offering both formats may expand access to different groups, while fostering similar outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The association and overlap between different forms of negative thought processes in insomnia is largely unknown. The purpose of the current investigation was to examine conceptual overlap between three insomnia-specific negative thought processes; catastrophizing, worry, and rumination, identify the underlying factors, and explore their associations with insomnia symptoms. Methods: A total of 360 students completed three insomnia-related negative thought process scales (Catastrophic Thoughts about Insomnia Scale, Anxiety and Preoccupation about Sleep Questionnaire, Daytime Insomnia Symptom Response Scale) and two insomnia symptoms measures (the Insomnia Severity Index and Sleep Condition Indicator). Results: The three scales and their subscales displayed acceptable reliabilities. Further, confirmatory factor analysis was supportive of the notion of catastrophizing, worry, and rumination measures as distinct. The catastrophizing and worry constructs were significantly associated with insomnia symptoms, but the rumination factor was not. Conclusions: The findings indicate that catastrophizing, worry, and rumination might be viewed as distinct constructs. Although more research is warranted on the topic of conceptual overlap, the current results might have implications for the development of models of insomnia, clinical research, and practice. [ABSTRACT FROM AUTHOR]

Hyperarousal is a key symptom of anxiety, stress-related disorders, and insomnia. However, it has been conceptualized in many different ways, ranging from various physiological markers (e.g. cortisol levels, high-frequency EEG activity) to personality traits, or state assessments of subjective anxiety and tension. This approach resulted in partly inconsistent evidence, complicating unified interpretations. Crucially, no previous studies addressed the likely variability of hyperarousal within and across days, nor the relationship of such variability in hyperarousal with the night-by-night variability in sleep quality characteristic of insomnia. Here, we present a novel data-driven approach to understanding dynamics of state hyperarousal in insomnia. Using ecological momentary assessment, we tracked fluctuations in a wide range of emotions across 9 days in 169 people with insomnia disorders and 38 controls without sleep problems. Exploratory factor analysis identified a hyperarousal factor, comprised of items describing tension and distress. People with insomnia scored significantly higher on this factor than controls at all timepoints. In both groups, the hyperarousal factor score peaked in the morning and waned throughout the day, pointing to a potential contributing role of sleep or other circadian processes. Importantly, the overnight increase in hyperarousal was stronger in people with in insomnia than in controls. Subsequent adaptive LASSO regression analysis revealed a stronger overnight increase in hyperarousal across nights of worse subjective sleep quality. These findings demonstrate the relationship between subjective sleep quality and overnight modulations of hyperarousal. Disorders in which hyperarousal is a predominant complaint might therefore benefit from interventions focused on improving sleep quality. [ABSTRACT FROM AUTHOR]

Patients with central hypersomnia (HCO) often show symptoms of depression. Despite of many studies conducted in this field, the link between these two disorders remains unclear. In order to contribute data to this research, we examined the question of which depressive symptoms characterize these patients. Furthermore, we investigated the differences between HCO who were more or less depressed regarding insomnia, sleep quality and daytime tiredness. The retrospective analysis assesses the presence and kind of depressive symptoms as measured by the Beck Depression Inventory (BDI) in 168 HCO including narcolepsy type I (NAR1), narcolepsy type II (NAR2) and idiopathic hypersomnia (HYP). Sleep parameters from one night of polysomnography, scores of questionnaires for insomnia and for daytime sleepiness, and data from sustained attention tests were compared between HCO with and without depression, as determined by BDI scores (cut off >12). According to BDI scores 52% exhibited no depression. The BDI items pertaining to tiredness and work inhibition exhibited elevated scores, whereas those pertaining to suicidality showed low scores. No difference was found between depressed and non-depressed HCO with regard to daytime vigilance performance or daytime sleepiness. However, depression was associated with older age, higher insomnia scores, and a shorter sleep time on polysomnography. A potential interpretation of our findings is that depressive symptoms in HCO may be a consequence of restricted life quality due to hypersomnia. Thus, therapeutical effort should focus more intensely on coping strategies. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the prevalence of depression, anxiety and insomnia in pregnant Chinese women, and to explore the related risk factors across multiple fields. Method: The participants were 2120 women (Mage = 30.24 years, range = 19–47) from 12 provinces in China. Bivariate correlation and logistic regression analyses were used to explore the risk factors. Chi-square tests and t tests were used to examine whether there were significant differences in mental health status between pregnant women in different periods of gestation. Results: The overall prevalence rates of depression, anxiety and insomnia among pregnant Chinese women were 10.0%, 3.8% and 3.3%, respectively. Risk factors for the mental health of pregnant women were identified across demographic, maternal, physiological, and psychological domains. Among these, severe mobility restrictions and fear of childbirth were found to be the strongest predictors. Conclusions: The prevalence of depression, anxiety and insomnia among pregnant women is low. Pregnant women with a seriously impaired ability to move and fear of childbirth are more likely to experience mental health problems. KEY POINTS: What is already known about this topic: Depression, anxiety, and insomnia are common mental health problems among pregnant women. Prevalence rates vary significantly across different countries and regions. Particularly in a large country like China, prevalence rates differ substantially among different regions. While risk factors for mental health of pregnant women span multiple domains, such as physiological and demographic domains, the most influential factors remain unclear. What this topic adds: A large-scale study from 12 provinces in China showed relatively low prevalence rates of depression, anxiety, and insomnia among pregnant women. Among the numerous factors influencing mental health, severe mobility restrictions and fear of childbirth emerged as the most robust predictors. [ABSTRACT FROM AUTHOR]

Sleep problems are common in children with autism spectrum disorder. Although previous research has shown the positive effects of parent-based sleep intervention, it was mainly focused on face-to-face modality, which might limit accessibility. This study aimed to examine the efficacy of a telehealth-delivered parent-based sleep-focused intervention in treating insomnia in preschool children with autism spectrum disorder. A total of 62 parents/caregivers with a child with autism spectrum disorder and comorbid insomnia (aged 3–6 years) were randomized to receive either three weekly group sessions of sleep-focused intervention via Zoom with telephone support (n = 30) or treatment as usual (n = 32). The intervention group had significantly greater improvements in overall sleep problems (Children's Sleep Habit Questionnaire total score; p < 0.05), bedtime resistance (p < 0.05), and sleep-onset delay (p < 0.05) at post-treatment as compared to the treatment as usual group. The intervention group also showed significant improvements in overall behavioral and emotional problems (p < 0.05), especially externalizing problems (p < 0.05) as measured by Strengths and Difficulties Questionnaire, and parental stress level (p < 0.05) as measured by Depression, Anxiety and Stress Scale-21 as compared to the treatment as usual group (partial η2 = 0.081–0.101). The findings supported the feasibility and promising effects of a brief parent-based sleep intervention delivered via telehealth. Sleep problems are common in children with autism spectrum disorder. Although the effects of parent-based sleep intervention were shown to be promising, previous research was limited to the face-to-face service model, which might limit accessibility. This study examined a sleep-focused parent training group delivered via telehealth for treating insomnia in preschool children with autism spectrum disorder, which allowed parents to join the intervention remotely. Results showed that children in the intervention group had greater improvements in sleep and insomnia symptoms after treatment, as compared to those who only received care as usual. This sleep-focused treatment also led to improved daytime behaviors, especially externalizing problems such as hyperactivity and conduct problems, in children with autism spectrum disorder. Parents who had attended the training also reported reduced parental stress level after treatment. The findings supported the feasibility and promising effects of a brief parent-based sleep intervention delivered via telehealth for preschooler with autism spectrum disorder. [ABSTRACT FROM AUTHOR]

• Sleep and circadian problems are often comorbid with mental disorders. • Sleep and circadian problems are mechanistic contributors to mental disorders. • TranS-C treats sleep and circadian problems across mental disorders via one protocol. • TranS-C is grounded in basic sleep and circadian science and existing EBPTs. • TranS-C includes cognitive-behavioral therapy for insomnia (CBT-I) The transdiagnostic intervention for sleep and circadian dysfunction (TranS-C) was developed to provide one protocol that treats a range of sleep and circadian problems across a range of mental disorders. The focus of TranS-C includes, and goes beyond, categorically defined sleep and circadian disorders to facilitate healthy sleep along empirically derived "sleep health" dimensions. In this State of the Science review, we highlight key advantages of a transdiagnostic approach to sleep and circadian problems, including (a) the potential to better understand and treat comorbidity between various sleep and circadian problems and mental disorders, as well as the potential to better understand and treat the heterogeneous sleep and circadian problems that are present within a specific mental disorder; (b) the opportunity to explore the hypothesis that sleep and circadian problems are an important transdiagnostic mechanism in the multifactorial maintenance of mental disorders; (c) the potential to transfer breakthroughs made across siloed areas of research and practice; (d) its suitability for dissemination into a broad range of settings, particularly lower resource settings; and (e) the opportunity to improve a range of important outcomes. We also explain the theoretical underpinnings of TranS-C, including the two-process model of sleep regulation and the Sleep Health Framework. TranS-C includes cognitive-behavioral therapy for insomnia (CBT-I) and we offer recommendations for when to use CBT-I versus TranS-C. The process for developing TranS-C is discussed along with outcome data, applications to underserved communities, and future directions for research. [ABSTRACT FROM AUTHOR]

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

Background: Digital therapeutics (DTx) have attracted attention as the substitutes or add-ons to conventional pharmacotherapy and the number of DTx products authorized with the regulatory reviews of the clinical evidence is increasing. Insomnia is one of the major targets of the DTx due to the benefit from cognitive behavioral interventions and several products have been launched in the market with regulatory reviews. However, common features of the products and the clinical evidence required by each regulatory agency have not been investigated. Methods: In this study, we identified the DTx products with the primary indication of insomnia authorized with regulatory reviews of clinical evidence by literature and website searches, and investigated the common features of the products and of the study designs for the pivotal clinical trials. Results: The total of 6 DTx products were identified. The components of cognitive behavioral therapy for insomnia (CBT-I) were identified as common features of the products. All the pivotal clinical trials were randomized, parallel-group, blind studies against insomnia patients. No products have been authorized in multiple countries regardless of the similarity of the features of the products and of the study designs for the pivotal clinical trials. Conclusions: Our study revealed that the components of CBT-I and gold standard design in pivotal clinical trials were adopted in all the DTx products for insomnia authorized with reviews of clinical evidence. At the same time, our findings suggest the needs of internationally harmonized regulatory review and authorization system to facilitate the early patient access to the promising DTx products. [ABSTRACT FROM AUTHOR]

Improving public health approaches to suicide prevention requires scalable evidence-based interventions that can be easily disseminated. Given empirical data supporting the association between insomnia and suicide risk, internet-delivered insomnia interventions are promising candidates to meet this need. The purpose of this study was to examine whether an unguided internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) improved insomnia severity, suicidal ideation (SI), and suicide risk correlates (depression, post-traumatic stress disorder, anxiety, hostility, belongingness, hopelessness, agitation, irritability, concentration) in a sample of veterans. Secondary data analysis of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 50) with clinically significant insomnia and elevated SI drawn from a larger randomized controlled trial (RCT) of an iCBT-I, Sleep Healthy Using the Internet (SHUTi). Two-sample t -tests or Wilcoxon rank sum tests were used to evaluate between-group differences (SHUTi vs. Insomnia Education Website control) in symptom improvement from baseline to post-intervention. SHUTi participants experienced a significant improvement in insomnia severity (P <.001; d = −1.08) and a non-significant with small (subthreshold medium) effect size reduction of SI (P =.17, d = 0.40), compared to control participants. Significant improvement in hopelessness was observed (medium effect size), with non-significant small to medium effect size reductions in most remaining suicide risk correlates. Self-administered iCBT-I was associated with improvements in insomnia severity in veterans at elevated risk for suicide. These preliminary findings suggest that SI and suicide risk correlates may improve following an iCBT-I intervention, demonstrating the need for future well-powered iCBT-I RCTs targeted for populations at elevated suicide risk. [ABSTRACT FROM AUTHOR]

Behavioural sleep problems are very common in children and are concerns for many parents. This review discusses normal sleep physiology and sleep development and focuses on common behavioural sleep problems in childhood, including behavioural insomnia of childhood, parasomnias and sleep-related movement disorders, highlighting their clinical features and management. Behavioural insomnia of childhood is characterised by learned difficulties in falling asleep and/or staying asleep. Management includes establishing bedtime routines and behavioural techniques. Parasomnias include confusional arousals, sleepwalking, sleep terrors and nightmares, and these usually resolve with time. Management includes parental reassurance and behavioural interventions such as scheduled awakening. With regards to sleep enuresis, management includes behavioural modifications, enuresis alarm and desmopressin. Sleep-related movement disorders include sleep-related bruxism and sleep-related rhythmic movements, of which body rocking is the most common. Early identification and management of behavioural sleep problems may prevent their negative impact on children as well as their families. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this investigation was to compile existing observational research and quantify the potential association between ultra-processed foods (UPFs) and the risk of insomnia using meta-analysis. Setting: We conducted a systematic search of the PubMed/MEDLINE, Scopus, and ISI Web of Science databases with no restrictions until 29 June 2024. Odds ratios (OR) and 95% confidence intervals (CI) were aggregated using a random-effects model, while the Newcastle-Ottawa Scale and Egger's regression asymmetry test assessed study quality and publication bias, respectively. Results: Analysis of data from seven studies showed a significant positive association between higher intake of UPFs and an increased risk of insomnia (OR = 1.53; 95% CI: 1.20, 1.95; I2 = 62.3%; p = 0.014). Subgroup analysis indicated this positive relationship was particularly strong under the NOVA food classification (OR = 1.57; 95% CI: 1.03, 2.40; I2 = 78.5%; p = 0.009; n = 3) and with snack intake (OR = 1.33; 95% CI: 1.04, 1.71; I2 = 0.0%; p < 0.001; n = 2), compared to adherence to Western dietary patterns. Moreover, subgroup analysis based on age group showed that higher UPF intake was significantly associated with increased risk of insomnia among adolescents (OR = 1.55; 95% CI: 1.21, 1.99; I2 = 57.4%; p < 0.001) but not in adults. Conclusions: Our findings underscore a significant association between higher consumption of UPFs and increased risk of insomnia, particularly among adolescents. Further research is necessary to explore the intricacies of this association and to ensure the generalizability of these results. [ABSTRACT FROM AUTHOR]