Correlations among insomnia symptoms, sleep medication use and depressive symptoms

Background: Recent studies link insomnia with increased risk of hypertension. The reasons for this association are unknown but may be related, in part, to decreased levels of physical activity and cardiorespiratory fitness. Additionally, sleep medication often has multiple deleterious side effects that may impact a person’s engagement in physical activity. We hypothesized that insomnia symptoms and sleep medication use were associated with reduced cardiorespiratory fitness. Methods: Adults (n=606) enrolled in the Emory-Georgia Tech Predictive Health Institute study completed baseline demographic, clinical, depression (Beck Depression Inventory II; BDI-II), sleep (Pittsburg Sleep Quality Index , PSQI) and cardiorespiratory fitness (maximal oxygen consumption; VO2max) measures. Insomnia symptoms (sleep latency of ≥30 minutes, nighttime or early morning awakenings) and sleep medication use ≥1 times/week were derived from the PSQI. Multiple linear regression was performed to test for associations between cardiorespiratory fitness and insomnia symptoms or sleep medication use. Results: The sample was 68% female, 25% African American, 41% normotensive, 33% prehypertensive, 26% hypertensive with a mean age of 48±11 years and mean body mass index (BMI) 27.6±6.3 kg/m2. Sleep medication use was reported in 11.9% of normotensives and was inversely associated with VO2max adjusting for age, gender, ethnicity, BMI, and heart rate (β=-0.12, p=.03, adjusted R2=.36) and remained significant after further adjustment for blood pressure, HDL cholesterol, depression and smoking (β=-0.11, p=.03, adjusted R2=.41). Sleep medication use was reported in 18.4% of prehypertensives and 22.8% of hypertensives but was not significantly associated with VO2max in either group. No evidence of association between insomnia symptoms and VO2max was found. Conclusion: Sleep medication was related to reduced cardiorespiratory fitness in normotensives. People who use sleep medication may be less physically active placing them at greater cardiovascular risk which has important clinical implications for risk reduction. This relationship is attenuated in prehypertension or hypertension and may reflect the influence of pathophysiology and other variables.

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753 The role of circadian activity rhythms in depressive symptoms among female nursing students

SLEEP ◽

10.1093/sleep/zsab072.750 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A293-A294

Author(s):

Xin Zhang ◽

Shih-Yu Lee

Keyword(s):

Nursing Education ◽

Depressive Symptoms ◽

Nursing Students ◽

Conceptual Model ◽

Depression Scale ◽

Psychological Problems ◽

Circadian Activity ◽

Activity Rhythms ◽

Wrist Actigraphy ◽

Insomnia Symptoms

Abstract Introduction Depression is prevalent among nursing students. Rumination and sleep-wake rhythms are associated to mental illness; however, no clear path has been found. This exploratory study aimed to examine the associations among circadian activity rhythms (CAR), rumination, and depressive symptoms in female nursing students; further, to test a hypothesized CAR conceptual model. Methods A total of 148 female nursing junior students in China completed a battery of questionnaires, including Athens Insomnia Scale (AIS), Ruminative Responses Scale (RRS), and Self-rating Depression Scale (SDS). Wrist actigraphy was used to collect total sleep time, CAR, and acrophase (time of the peak of the fitted activity curve). The path analysis was explored by using SPSS and AMOS. Results The mean age of the students was 20.64 years (SD = 0.86). About 58.8% of the participants were either mild or moderate depressed. About 93.9% of the students reported significant insomnia symptoms (AIS scores >6). Rumination was measured by the RRS (M= 2.01, SD = 0.54), and students scored higher in brooding than that of reflective pondering (2.07 vs. 1.95). The average of TST was 394.59 minutes (SD = 51.92). The CAR ranged from 0.40 to 0.98, with a mean of 0.75 (SD = 0.11). The acrophase ranged from 12:46 to 20:14 (median 16:30), with a later acrophase indicates of a more delayed circadian phase. The final model shows satisfactory fit (χ2= 2.238, p= .327); a better CAR can indirectly reduce depressive symptoms by directly reducing brooding (B = -1.149) and improving insomnia symptoms (B = -6.6443). Conclusion In order to prevent psychological problems of nursing students, ruminating and CAR should be part of health screening. The novel conceptual model provides a basis for reforming nursing education to prevent psychological problems. Support (if any) Chinese National Natural Science Foundation [71603279]

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379 Do Depressive Symptoms Mediate the Association Between Insomnia and Physical Activity?

SLEEP ◽

10.1093/sleep/zsab072.378 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A150-A151

Author(s):

Jamie Walker ◽

Rebecca Campbell ◽

Ivan Vargas

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Online Survey ◽

Longitudinal Design ◽

Energy Levels ◽

Depression Scale ◽

Severity Index ◽

Future Research ◽

Activity Levels ◽

Insomnia Symptoms

Abstract Introduction Insomnia and depression are highly comorbid and have been shown to be independently associated with lower levels of physical activity. It is not clear, however, if being less physically active is a risk factor for or consequence of depression and insomnia. The factors that explain the associations between insomnia, depression, and physical activity are likely complex and overlapping. For example, insomnia may predict inactivity by impacting one’s energy levels, leaving them too tired to exercise. Insomnia may also interfere with one’s motivation to exercise due to low mood, as insomnia is associated with the development of depressive symptoms. The purpose of the present study was to explore whether depression mediated the link between insomnia and low levels of physical activity. Methods A national online survey was conducted from April-June 2020. Participants completed surveys to assess demographics, mood, sleep, and physical activity. Depressive symptoms were estimated with the Center for Epidemiologic Studies Depression Scale (CES-D). Insomnia symptoms were estimated with the Insomnia Severity Index (ISI). Physical activity levels were estimated with the International Physical Activity Questionnaire (IPAQ). Analyses were conducted using multiple linear regression, with separate models for depression, insomnia, and the combination of the two, on levels of physical activity. Results 3,952 adults (Mage = 46.9 years) completed the survey. According to the unadjusted models, greater insomnia symptoms were associated with greater depressive symptoms (b = 0.4523, SE = 0.019593, p < .001), and lower levels of physical activity (b = -38.741, SE = 18.236, p = 0.0337). The relationship between insomnia and physical activity was no longer significant, however, when controlling for depression (b = -6.140, SE = 19.274, p = 0.75). According to the mediation analyses, there was an indirect effect of insomnia on physical activity that was explained by differences in depressive symptoms (Sobel Test = -4.895, SE = 6.518, p < .001). Conclusion Our findings support previous research indicating associations between symptoms of insomnia and depression and physical activity. Future research should examine if these same results hold using a longitudinal design. Support (if any) Vargas: K23HL141581

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663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic

SLEEP ◽

10.1093/sleep/zsab072.661 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A259-A259

Author(s):

Kathleen O’Hora ◽

Mateo Lopez ◽

Allison Morehouse ◽

Andrea Cordero ◽

Raquel Osorno ◽

...

Keyword(s):

Depressive Symptoms ◽

Outcome Measures ◽

Symptom Severity ◽

Post Treatment ◽

Symptom Improvement ◽

Depression Symptoms ◽

Insomnia Symptom ◽

The Impact ◽

Insomnia Symptoms ◽

Rate Of Improvement

Abstract Introduction The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown. Methods At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework. Results There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p < 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102). Conclusion This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample. Support (if any):

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Insomnia in Sweden: A Population-Based Survey

Sleep Disorders ◽

10.1155/2014/843126 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 23

Author(s):

Lena Mallon ◽

Jan-Erik Broman ◽

Torbjörn Åkerstedt ◽

Jerker Hetta

Keyword(s):

Sleep Duration ◽

Telephone Interview ◽

Age Groups ◽

Public Health Problem ◽

Population Based ◽

Need For Treatment ◽

Sleep Medication ◽

Insomnia Disorder ◽

Insomnia Symptoms ◽

Population Based Survey

Aims. Estimate the prevalence of insomnia and examine effects of sex, age, health problems, sleep duration, need for treatment, and usage of sleep medication.Methods. A sample of 1,550 subjects aged 18–84 years was selected for a telephone interview. The interview was completed by 1,128 subjects (72.8%).Results. 24.6% reported insomnia symptoms. Insomnia disorder, that is, insomnia symptoms and daytime consequences, was reported by 10.5%. The prevalence was similar among all age groups, with the exception of women aged 40–49 years who demonstrated a significantly higher prevalence, 21.6%. Having at least one physical or psychiatric disorder was reported by 82.8% of subjects with insomnia disorder. Mean sleep duration for subjects with insomnia disorder was 5.77 hours on weeknights and 7.03 hours on days off/weekends. The corresponding figures for subjects without insomnia disorder were 7.04 hours and 7.86 hours, respectively. Among those with insomnia disorder 62.5% expressed a need for treatment, and 20.0% used prescribed sleep medication regularly.Conclusions. Insomnia disorder is highly prevalent in the population. There are significant associations between insomnia disorder and physical and psychiatric disorders. A majority of subjects with insomnia disorder expressed a need for treatment, indicating a public health problem.

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The Relationship between Sleep Hygiene, Mood, and Insomnia Symptoms in Men with Prostate Cancer

10.21203/rs.3.rs-665325/v1 ◽

2021 ◽

Author(s):

Kathleen T. Galvin ◽

Sheila N. Garland ◽

Erik Wibowo

Keyword(s):

Prostate Cancer ◽

Depressive Symptoms ◽

Daytime Sleepiness ◽

Online Survey ◽

Psychological Symptoms ◽

Sleep Hygiene ◽

Psychological Conditions ◽

Mailing Lists ◽

Anxiety Depression ◽

Insomnia Symptoms

Abstract PurposeInsomnia symptoms are commonly experienced by men after prostate cancer (PCa) treatment. Here we explored how sleep hygiene behaviours and psychological symptoms are associated with insomnia symptoms in PCa patients.MethodsAn online survey was posted on social media and sent to mailing lists of PCa and general cancer organisations. The survey collected information on demographic, sleep hygiene and psychological symptoms using validated questionnaires. ResultsData from 142 participants were compared based on the absence (age = 68.3 ± 8.9 years) and presence (age = 66.6 ± 9.0 years) of insomnia symptoms. Participants with insomnia symptoms had significantly higher levels of anxiety, depression, fatigue, and daytime sleepiness as well as poorer sleep hygiene than those without insomnia symptoms. Control variables (age, comorbidities, ADT experience and BMI) accounted for 12.5% of the variance in insomnia symptoms. Adding sleepiness, fatigue, anxiety, depressive symptoms to the model explained an additional 45.1% of the variance in insomnia symptoms. Further, including the sleep hygiene item “I think, plan, or worry when I am in bed” and “I sleep in an uncomfortable bedroom” explained an additional 3.6% of the variance in insomnia symptoms. ConclusionsPoor sleep hygiene, fatigue, daytime sleepiness, anxiety, depressive symptoms were all associated with worse insomnia symptoms in PCa patients. Improving sleep hygiene and treating psychological conditions may potentially help prevent and/or alleviate insomnia symptoms in PCa patients.

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179 Insomnia Symptoms in Latinx emerging adults: The role of perceived discrimination

SLEEP ◽

10.1093/sleep/zsab072.178 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A73-A73

Author(s):

Pablo Soto ◽

Joseph Dzierzewski ◽

Mayra Ramos ◽

Natalie Dautovich ◽

Rosalie Corona

Keyword(s):

Depressive Symptoms ◽

Gender Identity ◽

Emerging Adulthood ◽

Emerging Adults ◽

Perceived Discrimination ◽

Cultural Factors ◽

Depression Symptoms ◽

Symptom Presentation ◽

Final Model ◽

Insomnia Symptoms

Abstract Introduction An individual’s culture presents unique risk and protective factors related to sleep outcomes. Similarly, emerging adulthood also represents a unique developmental period as it relates to sleep. The study of cultural factors during emerging adulthood is critical for better understanding the development of sleep dysfunction in vulnerable segments of the population. The present study investigated the association between perceived discrimination and insomnia symptoms in Latinx emerging adults. We hypothesized that perceived discrimination would result in higher insomnia symptom presentation above and beyond anxiety and depressive symptoms. Methods Participants included 198 (73.7% female; mean age=18.96) college-aged individuals self-identifying as Hispanic/Latinx who completed an online survey that assessed perceived racial/ethnic discrimination (Everyday Discrimination Scale; EDS), anxiety symptoms (General Anxiety Disorder Scale; GAD-7), depression symptoms (Patient Health Questionnaire; PHQ-9), and insomnia symptoms (Insomnia Severity Index; ISI). A three-block hierarchical regression was used to assess the impact of perceived discrimination on the presentation of insomnia symptomology above and beyond demographic characteristics and anxiety and depressive symptoms. Results The final model significantly predicted insomnia symptom presentation, F(5, 191)=26.379, p<.001, R2=.408. When age and gender identity were entered into the model they did not significantly predict insomnia symptoms F(2, 194)=.199, p=.82, R2=.002. Blocks 2, anxiety and depression symptoms (∆R2=.388), and 3, perceived discrimination (∆R2=.018), accounted for significant change in variance. In the final model, perceived discrimination significantly predicted insomnia symptoms (β=.151) above and beyond age (β=.016), gender identity (β= -.085), anxiety (β= -.075), and depression (β=.621). Conclusion Results suggest that discrimination among Hispanic/Latinx emerging adults is a unique contributor that may explain some of the higher prevalence rates of insomnia symptomology in this segment of the population. As such, it would be beneficial to tailor existing approaches aimed at improving sleep outcomes by accounting for stressors that could result from or influence discrimination against the individual and incorporate other cultural factors into treatment protocols. Support (if any) National Institute on Aging (K23AG049955, PI: Dzierzewski).

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THE EARLY BIRD GETS THE WORM, NOT ANXIETY OR DEPRESSION: HOW INSOMNIA SYMPTOMS PREDICT ANXIETY AND DEPRESSION

Innovation in Aging ◽

10.1093/geroni/igz038.174 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S45-S45

Author(s):

Courtney J Bolstad ◽

Anisha L Thomas ◽

Michael R Nadorff

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Regression Analyses ◽

Symptoms Of Depression ◽

Early Bird ◽

The Impact ◽

Insomnia Symptoms

Abstract Symptoms of insomnia are associated with symptoms of depression and anxiety in older adults, yet less is known about the impact of specific forms of insomnia (i.e. onset, maintenance, and terminal insomnia). We explored how insomnia type predicted symptoms of anxiety and depression in older adults (n = 133; mean age 69, range 65-89). We hypothesized that onset and maintenance insomnia would have stronger relations to depression and anxiety than terminal insomnia. Regression analyses indicated that onset insomnia was the only significant predictor of anxiety symptoms, and maintenance was the only significant predictor of depressive symptoms. Thus, our findings suggest that despite overlap between depression and anxiety, insomnia may have different mechanisms of affecting each disorder. Implications for the treatment of anxiety and depressive symptoms by addressing insomnia problems will be discussed.

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