Effectiveness of a Multicomponent Group Treatment for Insomnia

1995 ◽  
Vol 23 (2) ◽  
pp. 109-127 ◽  
Author(s):  
Elisabeth Schramm ◽  
Fritz Hohagen ◽  
Jutta Backhaus ◽  
Stefanie Lis ◽  
Mathias Berger
Keyword(s):  
Sleep Quality ◽  
Group Treatment ◽  
Psychological Treatment ◽  
Sleep Onset ◽  
Sleep Diary ◽  
Management Problem ◽  
Sleep Onset Latency ◽  
Subjective Sleep Quality ◽  
Significant Treatment ◽  
Problem Solving Skills

The present study evaluates a multifaceted cognitive-behavioral group treatment in a routine clinical setting. The program consists of directly sleep related strategies such as sleep education, sleep restriction, stimulus control, relaxation, and cognitive restructuring. Also included are techniques that target illness maintaining factors such as stress-management, problem solving skills, and increase of activities. Twenty-eight physician-referred outpatients with chronic primary insomnia according to DSM-III-R criteria attended 11 weekly therapy-sessions. Results were obtained on a subjective and objective level using a sleep diary, questionnaires, and polysomnography, respectively. Pre- and post-treatment comparisons indicated significant changes on all main sleep diary variables, i.e. total sleep time, sleep efficiency, number of awakenings, sleep onset latency and wake after sleep onset, as well as for the global subjective sleep quality. Maximum improvement was reached after the more directly sleep-related part of the program. In addition, the intervention helped patients to reduce the amount and frequency of sleeping aids over time and improved their daytime-functioning. Subjective therapeutic gains were maintained at 3- and 12-month follow-ups. No significant treatment effects could be obtained on polysomnographic measures, taking into account that the baseline values were already in the normative range. After the intervention the patients were able to give a more realistic evaluation of their sleep. These results suggest that a multicomponent psychological treatment is beneficial for the improvement of sleep quality on a subjective level.

scholarly journals The serotonin transporter gene-linked polymorphic region (5-HTTLPR) and the sleep-promoting effects of tryptophan: A randomized placebo-controlled crossover study

2019 ◽  
Vol 33 (8) ◽  
pp. 948-954
Author(s):  
Jens H van Dalfsen ◽  
C Rob Markus
Keyword(s):  
Sleep Quality ◽  
Allelic Variation ◽  
Sleep Onset ◽  
Treatment Protocol ◽  
Sleep Diary ◽  
Transporter Gene ◽  
Subjective Sleep Quality ◽  
Subjective Sleep ◽  
Allele Group ◽  
S Allele

Background:The low-expressive short (S) allele of a functional polymorphism (5-HTTLPR) within the serotonin (5-hydroxytriptamine; 5-HT) transporter gene (SLC6A4) has been associated with a reduced functioning of the brain 5-HT system relative to the long (L) allele. As a consequence, the S-allele is found to predispose individuals to a higher risk of sleep quality reduction and clinical insomnia.Aims:The present study investigated whether subchronic pre-sleep tryptophan administration could compensate for this predisposition by improving sleep in 5-HTTLPR S-allele carriers.Methods:In a double-blind placebo-controlled crossover design a sample of homozygous 5-HTTLPR S-allele ( n = 47) and L-allele ( n = 51) carriers were assessed for subjective (sleep diary) and objective (actigraphy) sleep during a treatment protocol consisting of 1 week of placebo (1000 mg/day) and 1 week of tryptophan administration (1000 mg/day).Results:The results support the sleep-promoting effects of tryptophan. Tryptophan improved objective sleep efficiency and objective wake after sleep onset irrespective of allelic variation. There was a marginally significant improvement of subjective sleep quality in the 5-HTTLPR S-allele group but not in the L-allele group following tryptophan relative to placebo intake. In contrast, a significantly poorer sleep quality in the S-allele as opposed to the L-allele group in the placebo condition was not observed in the tryptophan condition.Conclusions:Tryptophan augmentation promises to be a valuable treatment strategy for sleep impairments related to genetic deficiencies in 5-HT functioning.

scholarly journals 0524 Web-Delivered CBT for Insomnia Intervention Improves Sleep Among Adults with Insomnia and Depressive Symptoms

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A200-A201
Author(s):  
P J Batterham ◽  
H Christensen ◽  
F P Thorndike ◽  
L M Ritterband ◽  
R Gerwien ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Sleep Quality ◽  
Large Scale ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Sleep Diary ◽  
Sleep Onset Latency ◽  
Sleep Diaries

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is the first line recommended treatment for adults with chronic insomnia. In a prior randomized controlled trial (RCT), data showed web-delivered CBT-I (SHUTi) reduced insomnia severity as well as symptoms of depression, among adults with insomnia and elevated depressive symptoms. The present study aimed to further evaluate the effectiveness of web CBT-I to improve sleep outcomes as measured by prospectively entered sleep diaries in this same sample. Methods A large-scale RCT (N=1149) of Australian adults with insomnia and depressive symptoms compared a 9-week, web CBT-I therapeutic with an attention-matched web program at baseline, posttest and 6-, 12-, and 18-month follow-ups. Although depression outcomes have been presented previously, the online sleep-diary derived variables have not yet been presented, including sleep-onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), number of awakenings, sleep quality, and total sleep time (TST). Sleep diaries were entered online for 10 days at each assessment period. Results Data showed web CBT-I participants demonstrated greater reductions from baseline to posttest compared with control for the following sleep variables: SOL (LS mean difference [95% CI]=-22.3 min [-29.2, -15.3]; p<.0001), WASO (-17.8 min [-23.4, -12.3]; p<.0001), and number of awakenings (-0.38 [-0.68, -0.09]; p=.0113). Web CBT-I also showed greater improvements in SE (9.18% [7.25%, 11.10%]; p<.0001) and sleep quality (0.41 [0.30, 0.53]; p<.0001) from baseline to posttest compared with control. TST was not significantly different between groups at posttest or 6-month follow-up, although it improved over baseline at 12 (18.73 min [7.39, 30.07]; p=.0013) and 18 months (23.76 min [9.15, 38.36]; p=.0015) relative to control. All other significant sleep treatment effects were maintained in the treatment arm at 6, 12, and 18-month follow-up. Conclusion Data showed web CBT-I produced lasting improvements in sleep outcomes among adults with insomnia and elevated depressive symptoms. Support Clinical trial ACTRN12611000121965 was funded by the Australian National Health and Medical Research Council. The statistical analysis described here was funded by Pear Therapeutics, Inc and conducted by Provonix.

scholarly journals Adults Consuming an Energy-Restricted US Healthy-Style Eating Pattern at Either the Recommended or a Higher Protein Quantity Perceive a Shift from “Poor” to “Good” Sleep

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 528-528
Author(s):  
Joshua Hudson ◽  
Jing Zhou ◽  
Wayne Campbell
Keyword(s):  
Sleep Quality ◽  
Dietary Protein ◽  
Sleep Onset ◽  
Sleep Onset Latency ◽  
Quality Indices ◽  
Subjective Sleep Quality ◽  
Eating Pattern ◽  
Subjective Sleep ◽  
Good Sleep ◽  
Over Time

Abstract Objectives Limited evidence from secondary analyses suggests consuming a higher protein diet during weight loss improves subjective indices of sleep in adults who are overweight and obese. We sought to a priori assess the effects consuming a U.S. Healthy–Style Eating Pattern with the recommended versus a higher amount of protein and moderate energy-restriction on sleep quality indices. Methods Using of a randomized, parallel-design, 51 men and women (mean ± SEM; age: 47 ± 1 y; BMI: 32.6 ± 0.5 kg/m2) consumed a controlled U.S. Healthy-Style Eating Pattern containing 750 kcal/d less than their estimated energy requirement for 12 wk. The additional dietary protein (7.5 oz-eq/d) came from animal-based protein sources and displaced primarily whole and reined grains. Objective and subjective sleep quality indices were measured using wrist-worn actigraphy and questionnaires (Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale), respectively, at pre-, mid- (week 6), and post-intervention (week 12). Results Among all participants, body mass decreased (-6.2 ± 0.4 kg). Dietary protein intake did not affect any of the objective or subjective sleep quality outcomes measured. Over time, objective measures of time spend in bed, time spent sleeping, sleep efficiency, sleep onset latency, and time awake after sleep onset did not change. Subjective measures of global sleep score (GSS, −3.8 ±0.4 au) and daytime sleepiness score (−3.8 ± 0.4 au; both P < 0.001) improved over time. The GSS improvement transitioned the group of participants from being categorized with a poor to a good sleep condition (GSS >5 versus ≤5 au of 0–21 au scale; Pre 7.9 ± 0.5 au, Post: 4.0 ± 0.6 au). Conclusions Although objective sleep quality may not improve, adults with poor sleep may perceive becoming good sleepers while consuming a moderately energy-restricted U.S. Healthy-Style Eating Pattern containing either the recommended or a higher amount of protein. Funding Sources The Beef Checkoff and American Egg Board-Egg Nutrition Center.

Sleep Quality Associated With Different Work Schedules: A Longitudinal Study of Nursing Staff

2017 ◽  
Vol 19 (4) ◽  
pp. 375-381 ◽  
Author(s):  
Shu-Fen Niu ◽  
Nae-Fang Miao ◽  
Yuan-Mei Liao ◽  
Mei-Ju Chi ◽  
Min-Huey Chung ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Night Shift ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Diary ◽  
Sleep Onset Latency ◽  
Shift Group ◽  
Parallel Group ◽  
Sleep Parameters ◽  
Work Shifts

Purpose: To explore the differences in sleep parameters between nurses working a slow, forward rotating shift and those working a fixed day shift. Method: A longitudinal parallel-group comparison design was used in this prospective study. Participants (female) were randomly assigned to a rotating shift or a fixed day shift group. Participants in the rotating shift group worked day shift for the first 4 weeks, followed by evening shift for the second and night shift the third. Those in the day shift group worked day shift for all 12 weeks. Each kept a sleep diary and wore an actigraph (actigraph data were used to calculate total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO], and sleep efficiency [SE]) for 12 days, from Workday 1–4 in each of Weeks 4, 8, and 12. Results: TST in nurses working evening rotating shift was higher than that for those working the day or night rotating shift and fixed day shift. WASO was significantly longer on Day 2 for rotating shift participants working evening versus day shift. SOL and SE were significantly shorter and lower in rotating shift nurses working night versus both day and evening shifts. Conclusions: A comprehensive understanding of the sleep patterns and quality of nurses with different work shifts may lead to better management of work shifts that reduces the influence of shift work on sleep quality.

Sleep of Wheelchair Rugby Athletes: Training, Rest and Competition

2020 ◽  
Author(s):  
Victor Sanz-Milone ◽  
Fernanda V. Narciso ◽  
Andressa da Silva ◽  
Milton Misuta ◽  
Marco Túlio de Mello ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Onset ◽  
Sleep Efficiency ◽  
Sleep Diary ◽  
Poor Sleep ◽  
Subjective Sleep Quality ◽  
Wheelchair Rugby ◽  
Rest Periods ◽  
Rugby Players

AbstractThe aim of this study was to evaluate the sleep-wake cycle of wheelchair rugby athletes during the pre-season compared to in-season. Wheelchair Rugby athletes wore an actigraph monitor during two respective 10-day periods: 1) pre-season and 2) in-season, each of which comprised three training days, three rest days, and four competition days, respectively. In addition, the players completed questionnaires regarding sleepiness, subjective quality of sleep, and chronotype, as well as the use of the sleep diary along with the actigraph measurements (20 days). The wheelchair rugby athletes had poor subjective sleep quality in both stages observed by sleep efficiency below 85% (ES 0.31) and high score in the Pittsburgh questionnaire (effect size-ES 0.55), the actigraphy results presented an increase of sleep latency (ES 0.47), and wake after sleep onset (ES 0.42). When comparing the athlete’s routine, the competition days, demonstrated a reduction in the total time of sleep and the sleep efficiency, in addition to an increase in wakefulness after sleep onset when compared with the training and rest periods. As a result, the wheelchair rugby players did not describe a pattern of sleep-wake cycle during different training phases, as well as poor sleep quality.

scholarly journals Relationship between Cortisol Changes during the Night and Subjective and Objective Sleep Quality in Healthy Older People

2020 ◽  
Vol 17 (4) ◽  
pp. 1264
Author(s):  
Matias M. Pulopulos ◽  
Vanesa Hidalgo ◽  
Sara Puig-Perez ◽  
Teresa Montoliu ◽  
Alicia Salvador
Keyword(s):  
Sleep Quality ◽  
Older People ◽  
Hpa Axis ◽  
Sleep Onset ◽  
Quality Data ◽  
Sleep Diary ◽  
Subjective Sleep Quality ◽  
Sleep Quantity ◽  
Subjective Sleep ◽  
Subjective Socioeconomic Status

The aim of this study was to investigate whether the nighttime cortisol release was associated with subjective and objective sleep quality and the discrepancy between them. Forty-five healthy older adults (age range from 56 to 75 years) collected salivary samples immediately before sleep and immediately after awakening on two consecutive nights. Actigraphy was used to assess objective sleep quality and quantity. A sleep diary was used to assess subjective sleep quality. Linear mixed models were performed using subjective and objective sleep quality data from 76 nights to investigate between-subject associations. We observed that larger changes in cortisol levels between sleep onset and awakening, reflecting a healthier circadian rhythm of the Hypothalamic-Pituitary-Adrenal (HPA) axis, were associated with better subjective sleep quality, but not with objective sleep quality. Moreover, smaller changes in nighttime cortisol were associated with lower subjective sleep quality relative to objective sleep quality. All these results were observed even after controlling for important confounders such as sleep quantity, age, sex, subjective socioeconomic status, stress perception, depression, physical activity, and adherence to the salivary sampling protocol. This study demonstrates that subjective sleep quality in older people may be explained, to some extent, by the activity of the HPA axis.

scholarly journals Assessing sleep-wake survival dynamics in relation to sleep quality in a placebo-controlled pharmacological intervention study with people with insomnia and healthy controls

2020 ◽  
Vol 238 (1) ◽  
pp. 83-94
Author(s):  
Lieke W. A. Hermans ◽  
Marta Regis ◽  
Pedro Fonseca ◽  
Sebastiaan Overeem ◽  
Tim R. M. Leufkens ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Onset ◽  
Sleep Fragmentation ◽  
Pharmacological Intervention ◽  
Segment Length ◽  
Prediction Errors ◽  
Sleep Onset Latency ◽  
Healthy Controls ◽  
Subjective Sleep Quality ◽  
Double Blind

Abstract Rationale The mechanisms underlying impaired sleep quality in insomnia are not fully known, but an important role for sleep fragmentation has been proposed. Objectives The aim of this study is to explore potential mechanisms of sleep fragmentation influencing alterations of perceived sleep quality. Methods We analyzed polysomnography (PSG) recordings from a double-blind crossover study with zopiclone 7.5 mg and placebo, in elderly participants with insomnia complaints and age-matched healthy controls. We compared survival dynamics of sleep and wake across group and treatment. Subsequently, we used a previously proposed model to estimate the amount of sleep onset latency (SOL) misperception from PSG-defined sleep fragmentation. Self-reported and model-estimated amount of SOL misperception were compared across group and treatment, as well as model prediction errors. Results In the zopiclone night, the average segment length of NREM sleep was increased (group F = 1.16, p = 0.32; treatment F = 8.89, p< 0.01; group x treatment F = 0.44, p = 0.65), while the segment length of wake was decreased (group F = 1.48, p = 0.23; treatment F = 11.49, p< 0.01; group x treatment F = 0.36, p = 0.70). The self-reported and model-estimated amount of SOL misperception were lower during the zopiclone night (self-reported group F = 6.08, p< 0.01, treatment F = 10.8, p< 0.01, group x treatment F = 2.49, p = 0.09; model-estimated F = 1.70, p = 0.19, treatment F = 16.1, p< 0.001, group x treatment F = 0.60, p = 0.55). The prediction error was not altered (group F = 1.62, p = 0.20; treatment F = 0.20, p = 0.65; group x treatment F = 1.01, p = 0.37). Conclusions Impaired subjective sleep quality is associated with decreased NREM stability, together with increased stability of wake. Furthermore, we conclude that zopiclone-induced changes in SOL misperception can be largely attributed to predictable changes of sleep architecture.

scholarly journals Yoga nidra practice shows improvement in sleep in patients with chronic insomnia: A randomized controlled trial

2021 ◽  
Vol 34 ◽  
pp. 143-150
Author(s):  
KARUNA DATTA ◽  
MANJARI TRIPATHI ◽  
MANSI VERMA ◽  
DEEPIKA MASIWAL ◽  
HRUDA NANDA MALLICK
Keyword(s):  
Sleep Quality ◽  
Salivary Cortisol ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Sleep Time ◽  
Chronic Insomnia ◽  
Sleep Diary ◽  
Subjective Sleep Quality ◽  
Subjective Sleep ◽  
Yoga Nidra

Background Yoga nidra is practised by sages for sleep. The practice is simple to use and has been clearly laid out, but its role in the treatment of chronic insomnia has not been well studied. Methods In this randomized parallel-design study conducted during 2012–16, we enrolled 41 patients with chronic insomnia to receive conventional intervention of cognitive behavioural therapy for insomnia (n=20) or yoga nidra (n=21). Outcome measures were both subjective using a sleep diary and objective using polysomnography (PSG). Salivary cortisol levels were also measured. PSG was done before the intervention in all patients and repeated only in those who volunteered for the same. Results Both interventions showed an improvement in subjective total sleep time (TST), sleep efficiency, wake after sleep onset, reduction in total wake duration and enhancement in subjective sleep quality. Objectively, both the interventions improved TST and total wake duration and increased N1% of TST. Yoga nidra showed marked improvement in N2% and N3% in TST. Salivary cortisol reduced statistically significantly after yoga nidra (p=0.041). Conclusion Improvement of N3 sleep, total wake duration and subjective sleep quality occurred following yoga nidra practice. Yoga nidra practice can be used for treatment of chronic insomnia after supervised practice sessions.

scholarly journals 0474 Long-Term Efficacy and Safety of Lemborexant in Elderly Adults with Insomnia Disorder: Results from SUNRISE-2

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A182-A182
Author(s):  
M Moline ◽  
Y Inoue ◽  
K Pinner ◽  
C Perdomo ◽  
G Filippov ◽  
...  
Keyword(s):  
Group Treatment ◽  
Sleep Onset ◽  
Safety Data ◽  
Sleep Diary ◽  
Elderly Subjects ◽  
Sleep Onset Latency ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Subjective Sleep ◽  
Patient Reported

Abstract Introduction In SUNRISE-2 (NCT02952820; E2006-G000-303), the dual orexin receptor antagonist lemborexant (LEM) demonstrated significant benefit versus placebo (PBO) on subjective sleep endpoints over 6mo in subjects age ≥18y; benefits were sustained over 12mo. Here we present 12mo efficacy and safety data for LEM from the elderly (≥65y) subgroup. Methods SUNRISE-2 was a 12mo, randomized, double-blind, PBO-controlled (first 6mo [Period 1]), global phase 3 study. During Period 1, subjects were randomized to PBO or LEM (5mg, [LEM5]; 10mg, [LEM10]). During Period 2 (second 6mo), LEM subjects continued their assigned dose while PBO subjects were rerandomized to LEM5 or LEM10 (not reported here). Patient-reported (subjective) sleep endpoints were assessed from sleep diary data (sleep onset latency [sSOL]; sleep efficiency [sSE]; wake after sleep onset [sWASO]). Results Of the 949 subjects in the Full Analysis Set, 262 were age ≥65y. At 6mo, in subjects ≥65y, median sSOL significantly decreased from baseline for LEM5 (−21.7) and LEM10 (−26.0) versus PBO (−10.8; P&lt;0.0001, P&lt;0.01, respectively). At 12mo, LEM5 and LEM10 subjects maintained decreases in median sSOL (−29.3, −34.3, respectively). At 6mo, the mean (SD) increase from baseline in sSE was significantly larger versus PBO (8.5[13.3]) for LEM5 (16.9[13.6]; P&lt;0.001) and LEM10 (14.9[15.9]; P&lt;0.01). At 12mo, mean (SD) increase in sSE was maintained for LEM5 (18.1[12.5]) and LEM10 (18.0[16.8]). At 6mo, mean (SD) change from baseline in sWASO was significantly decreased versus PBO (−26.5 [52.9]) for LEM5 and LEM10 (−54.8[64.4], P&lt;0.01; −51.4[69.3], P&lt;0.05, respectively). At 12mo, mean (SD) decrease in sWASO was maintained for LEM5 (−58.6[46.0]) and LEM10 (−60.9[80.4]). Over 12mo, the most common (&gt;10% either group) treatment emergent adverse events with LEM5 and LEM10, respectively, were somnolence (9.3%, 19.0%), nasopharyngitis (9.3%, 10.7%), and headache (10.5%, 6.0%). Conclusion In elderly subjects, LEM demonstrated efficacy at 6mo, which persisted at 12mo; LEM was well tolerated. Support Eisai Inc.

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