Insomnia Patients With Objective Short Sleep Duration Have a Blunted Response to Cognitive Behavioral Therapy for Insomnia

Abstract Introduction Several studies investigated the role of objective sleep markers, in particular of Total Sleep Time (TST) in identifying different subtypes of Insomnia Disorder (ID) and in evaluating the efficacy of treatments. Based on objective TST two phenotypes of ID are usually distinguished in the literature: normal sleepers (objective sleep duration ≥ 6 hours) and short sleepers (objective sleep duration < 6 hours). Aim of our study was to evaluate in normal and short sleepers (objective sleep duration was assessed by both Polysomnography and Actigraphy) possible different response to Cognitive-Behavioral Therapy for Insomnia (CBT-I). Methods 53 ID patients (females = 50.9%; mean age = 56.53±11.43) were divided into “Short Sleep duration” and “Normal Sleep duration” groups. All patients underwent 7-sessions group CBT-I. Main clinical outcome was Insomnia Severity Index questionnaire (ISI); secondary outcomes were Sleep Efficacy (SE), Sleep Latency (SL), Wake After Sleep Onset (WASO), Number of Awakenings (N°awk) according to sleep diaries. Results All ID patients showed significant improvements after treatment for all clinical outcomes. Non-significant effects of CBT-I between “Short Sleep duration” and “Normal Sleep duration” measured by patients were found in terms of ISI, SE, SL, WASO and N°awk, neither using Polysomnography nor Actigraphy. Furthermore, no accordance between these two objective measurements was found for the identification of the two subgroups. Conclusion Our findings suggest that the use of objective TST (both by Actigraphy and Polysomnography) is not a consistent predictor for CBT-I effectiveness. Moreover, only a small percentage of patients were classified as short or normal sleepers according both to Polysomnography and Actigraphy. These findings underline the instability and poor reliability of using objective TST in subtyping insomniacs. Support No

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374 Cognitive Behavioral Therapy with Exercise in Adults with Insomnia and Short Sleep: Daytime Function Outcomes from a Pilot Study

SLEEP ◽

10.1093/sleep/zsab072.373 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A149-A149

Author(s):

Andrew Kubala ◽

Mara Egeler ◽

Daniel Buysse ◽

Martica Hall ◽

Emma Barinas-Mitchell ◽

...

Keyword(s):

Sleep Duration ◽

Behavioral Therapy ◽

Exercise Program ◽

Short Sleep Duration ◽

Post Intervention ◽

Short Sleep ◽

Supervised Exercise ◽

Daytime Function ◽

Supervised Exercise Program ◽

Insomnia Severity

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is efficacious, but there is mixed evidence as to whether improvement is blunted in adults with insomnia and short sleep duration. Exercise training can reduce physiologic hyperarousal and may increase homeostatic sleep drive, which could potentiate CBT-I treatment effects. This pilot study explored changes in self-reported outcomes from a CBT-I intervention augmented by exercise training in a sample of adults with insomnia and objective short sleep duration. Methods Eight adults (50% female, 62.5% white) with insomnia disorder and short sleep duration (mean actigraphic TST <6.5 hr) completed a 12-week single-arm trial. Participants self-administered the online “Sleep Healthy Using the Internet” (SHUT-I) CBT-I program with additional staff guidance while completing a supervised exercise program (EX; 150 min/wk of moderate-intensity aerobic exercise and 2 days/wk of strength training). Participants completed assessments of self-reported sleep and daytime function pre- and post-intervention, including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), Ford Insomnia Response to Stress Test (FIRST), Perceived Stress Scale (PSS), and Epworth Sleepiness Scale (ESS). Differences between timepoints were analyzed using paired t-tests and Cohen’s d effect size calculations. Results Insomnia severity significantly decreased after the intervention (ISI: p<0.001, d=2.99), with 75% reporting post-intervention ISI ≤ 7. Likewise, fatigue significantly decreased after the intervention (FFS: p=0.032, d=0.95). Symptoms of stress-related sleep reactivity and stress were also reduced (FIRST: p=0.012, d=1.19; PSS: p=0.014, d=1.14). Though nonsignificant, large reductions in sleepiness were additionally observed (ESS: p=0.058, d=0.80). Conclusion In this pilot trial among patients with insomnia and short sleep duration, online CBT-I plus a supervised exercise program resulted in a significant reduction in insomnia severity. The intervention also produced large and meaningful reductions in fatigue and stress, which are common daytime impairments in patients with insomnia. Future research should attempt to disentangle the independent contributions of CBT-I and exercise on outcomes in this population. Support (if any) NIH: K23HL118318

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0401 Cognitive Behavioral Therapy for Insomnia is Equally Effective for Insomnia Patients With Short and Longer Objective Sleep Duration

SLEEP ◽

10.1093/sleep/zsy061.400 ◽

2018 ◽

Vol 41 (suppl_1) ◽

pp. A152-A153

Author(s):

C Yang ◽

Y Huang ◽

Y Jan ◽

H Lee

Keyword(s):

Cognitive Behavioral Therapy ◽

Sleep Duration ◽

Behavioral Therapy ◽

Cognitive Behavioral

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0470 A Randomized Controlled Trial of Digital Cognitive Behavioral Therapy for Insomnia in Pregnant Women

SLEEP ◽

10.1093/sleep/zsaa056.467 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A180-A180

Author(s):

D A Kalmbach ◽

A Cuamatzi-Castelan ◽

C V Tonnu ◽

T Roth ◽

R Sangha ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Sleep Quality ◽

Pregnant Women ◽

Sleep Duration ◽

Behavioral Therapy ◽

Depression Scale ◽

Emotional Dysregulation ◽

Cognitive Behavioral ◽

Control Group ◽

Randomized Controlled

Abstract Introduction Over half of pregnant women experience clinical insomnia, which is linked to perinatal depression and cognitive-emotional dysregulation. Despite high rates of prenatal insomnia and known maternal consequences, efficacious insomnia treatment options for this population are woefully scant. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy digital CBTI via mobile health app in pregnant women with insomnia. Methods Single-site RCT. Ninety-one pregnant women (29.03±4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. Blinded assessments were performed before treatment, after treatment (during pregnancy), and 6 weeks after childbirth. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale’s Cognitive factor (PSAS-C) served as study outcomes. Results From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p<.001) and PSQI (-2.98 points, p<.001) and increases in nightly sleep duration by 32 minutes. Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 minutes per night (p=.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed. Conclusion Digital CBTI improves sleep quality and increases sleep duration during pregnancy and after childbirth. Digitally delivered interventions have potential to improve the health of new and expectant mothers, but CBTI likely needs to be tailored for perinatal patients to optimize outcomes. Support This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach).

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SUN-569 The Normalization of Sleep Duratioin as a Factor of Glyhemoglobin Reducing

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1354 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Irina Dzherieva ◽

Natalya Volkova ◽

Maria Komurdzhyntcs ◽

Ilia Davidenko ◽

Lilia Ganenko ◽

...

Keyword(s):

Diabetes Mellitus ◽

Sleep Apnea ◽

Cognitive Behavioral Therapy ◽

Sleep Duration ◽

Diabetes Mellitus Type 2 ◽

Behavioral Therapy ◽

Depression Scale ◽

Diabetes Mellitus Type ◽

Cognitive Behavioral

Abstract Sleep deprivation is an important risk factor of the metabolic disorder. According to the systematic review published in the Circulation there are a lot of data from epidemiological, clinical and experimental researches which confirm this fact. The goal of our research was to assess the level of glycohemoglibin after the normalization of sleep duration. 24 patients with diabetes mellitus type2 (19 females and 7 males, average age 58.7 ±1.3 yer) were included in the research. Diabetes mellitus type 2 duration was 9.5 years. Criteria excluded were myocardial infarction, stroke, sleep apnea, oncological diseases and depression. To exclude depression we used the questionnaires: Center for Epidemiological Studies Depression Scale and The Hospital Anxiety And Depression Scale. To exclude sleep apnea we used questionnaire STOP-Bang score. The sleep duration was assessed by the patients self-reports. Glycohemoglibin was determined by Immunoinhibition Method Cobas 6000, Roche Diagnostics. The sleep duration was corrected by cognitive behavioral therapy. For statistic assess of the results we used the method Wilcoxon F. Results: At the beginning of the treatment the level of glyhemoglobin was 7.8% and the sleep duration was 6.4 hours.The included patients were treated by cognitive behavioral therapy for 6 months without changing other kinds of therapy. The sleep duration significantly(P=-0.35) enlarged until 7.5±0.2 hours and the level of glyhemoglobin was lowered by 0.4% significantly (P=0.47). The improving of sleep duration can successfully reduce the level of glyhemoglobin in diabetes mellitus type 2 without any intervention at glycemia and could contribute to the prevention of diabetes complications.

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