Insomnia

Objectives

The aim of this preliminary study was to evaluate if Sleep Restriction Therapy for insomnia is associated with modifications to physiological arousal, indexed through overnight measures of plasma cortisol concentrations and core body temperature.

Methods

In a pre-to-post open label study design, eleven patients with chronic and severe Psychophysiological Insomnia underwent 5 weeks of Sleep Restriction Therapy.

Results

Eight (73%) patients out of 11 consented completed therapy and showed a decrease in insomnia severity pre-to-post treatment (mean (SD): 18.1 (2.8) versus 8.4 (4.8); p = .001). Six patients were analyzed with pre-to-post overnight measures of temperature and cortisol. Contrary to our hypothesis, significantly higher levels of plasma cortisol concentrations were found during the early morning at post-treatment compared to baseline (p < .01), while no change was observed in the pre-sleep phase or early part of the night. Core body temperature during sleep was however reduced significantly (overall mean [95% CI]: 36.54 (°C) [36.3, 36.8] versus 36.45 [36.2, 36.7]; p < .05).

Conclusions

Sleep Restriction Therapy therefore was associated with increased early morning cortisol concentrations and decreased core body temperature, supporting the premise of physiological changes in functioning after effective therapy. Future work should evaluate change in physiological variables associated with clinical treatment response.

Sleep complaints are common problems in the general population and insomnia and sleep disorders place significant economic and social burdens on the community. Postmenopausal women are 2.6 to 3.5 times more likely to develop obstructive sleep apnea (OSA) compared to non-menopausal women. In this study, we evaluated sleep disorders and mental health in postmenopausal women. This study was a descriptive cross-sectional study and the samples were selected from postmenopausal women above 50 years who had participated in a survey entitled, &quot;Evaluation of Sleep Disorders among Adults in Tehran&quot; in 2017. Cluster sampling method was applied with proportional allocation. A total of 4021 samples were collected, 2075 of which belonged to women. In addition, 174 out of 2075 samples were related to postmenopausal women over the age of 50. The data were analyzed using the statistical package IBM SPSS version 22.0. P-values less than 0.05 were considered significant. In this study, 118 (...

Purpose
The objective of the survey is to evaluate the knowledge and opinion of Howard University College of Pharmacy first-year professional pharmacy students regarding the use of the sleep medication melatonin.
Methods
A survey questionnaire comprising 20 questions on melatonin was developed and response obtained from 42 students. Demographic data and responses were gathered and evaluated. Descriptive statistics were used to analyze the responses.
Results
Most of the respondents had adequate knowledge about melatonin ranging from 54.8 to 92.6%. There was no statistical difference when responses were analyzed based on the gender of the survey participants. To specific questions whether melatonin is
associated with weight gain, can help with signs and symptoms of cancer, recommend sleep hygiene instead of melatonin, and
whether melatonin is addictive, the majority (57.1%, 42.9%, 64.3% and 69.0%, respectively) provided the wrong responses.
Conclusion
More than half of the respondents had good levels of knowledge and opinion about melatonin, with the highest being 92.6% to
a specific question on the use of melatonin. The students were only deficient in areas of melatonin being associated with weight
gain, melatonin helping with signs and symptoms of cancer, recommending sleep hygiene, and melatonin causing addiction.
There are significant differences between the age groups and whether those who worth healthcare area, or not in their response
to some of the survey questions.

Context: According to Persian medicine text, there are some topical herbal remedies for insomnia such as pumpkin oil as a nasal drop.

Aims: To evaluate the effect of pumpkin oil (a Persian medicine product) in patients with chronic insomnia.

Methods: This study was conducted as a randomized double-blind clinical trial on pumpkin oil efficacy in 74 patients with chronic insomnia. The participants received two drops of intranasal pumpkin oil or placebo every night for two weeks. The effects of pumpkin oil and placebo on the pattern of sleep and sleep quality were assessed at baseline and at the end of two weeks of treatment by Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires.

Results: The scores of the ISI questioner were statistically different between groups after two weeks of intervention and patients in the pumpkin oil group had fewer scores for ISI questioner (p<0.001). The reduction of the total score of the Pittsburgh questioner was 10.08 ± 3.21 in the pumpkin oil group and 0.28 ± 0.98 (p<0.001) in the control group.

Conclusions: Pumpkin oil could have a significant positive effect on the quantity and the quality of sleep in patients with chronic insomnia.

Prevalence of adult ADHD and its treatment is increasing all around the world. However, number of undiagnosed cases of Adult ADHD is also increasing. Undiagnosed cases pose potential threat to patient, family and society at large. Hence need of spreading awareness about the disorder is imperative. Case bases communication is aimed to help sensitize, educate and enable medical doctors like psychiatrist, family practitioners, and pediatricians to diagnose ADHD adults. It is challenge to diagnose adult ADHD because of varying presentation, overlapping co morbid conditions, and above all lack of awareness or index of suspicion. Insomnia and forgetfulness since young age of this patient were adequate to trigger the alarm. Careful and well oriented history taking along with screening test can help clinician diagnose most treatable neuro developmental disorder.

Objectives To examine the associations of Intimate partner violence (IPV) with stress-related sleep disturbance (measured using the Ford Insomnia Response to Stress Test [FIRST]) and poor sleep quality (measured using the Pittsburgh Sleep Quality Index [PSQI]) during early pregnancy. Methods This cross-sectional study included 634 pregnant Peruvian women. In-person interviews were conducted in early pregnancy to collect information regarding IPV history, and sleep traits. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CIs) were calculated using logistic regression procedures. Results Lifetime IPV was associated with a 1.54-fold increased odds of stress-related sleep disturbance (95% CI: 1.08–2.17) and a 1.93-fold increased odds of poor sleep quality (95% CI: 1.33–2.81). Compared with women experiencing no IPV during lifetime, the aOR (95% CI) for stress-related sleep disturbance associated with each type of IPV were: physical abuse only 1.24 (95% CI: 0.84–1.83), sexual abuse only 3.44 (95%CI: 1.07–11.05), and physical and sexual abuse 2.51 (95% CI: 1.27–4.96). The corresponding aORs (95% CI) for poor sleep quality were: 1.72 (95% CI: 1.13–2.61), 2.82 (95% CI: 0.99–8.03), and 2.50 (95% CI: 1.30–4.81), respectively. Women reporting any IPV in the year prior to pregnancy had increased odds of stress-related sleep disturbance (aOR = 2.07; 95% CI: 1.17–3.67) and poor sleep quality (aOR = 2.27; 95% CI: 1.30–3.97) during pregnancy. Conclusion Lifetime and prevalent IPV exposures are associated with stress-related sleep disturbance and poor sleep quality during pregnancy. Our findings suggest that sleep disturbances may be important mechanisms that underlie the lasting adverse effects of IPV on maternal and perinatal health.

Autor(es): Sanchez, Sixto E; Islam, Suhayla; Zhong, Qiu-Yue; Gelaye, Bizu; Williams, Michelle A

Editorial: PLoS ONE
Revista: PloS one (PloS one)

Fecha de publicación: Mar-2016

URL: http://hdl.handle.net/10757/604529
DOI: http://dx.doi.org/10.1371/journal.pone.0152199

Objectives This study aims to assess the prevalence of health problems (eg, insomnia, binge-eating, substance use and ill health) among UK doctors and to investigate whether occupational distress increases the risk of health problems. Design This study reports the analysis of data collected at the baseline stage of a randomised controlled trial (protocol #NCT02838290). setting Doctors were invited through medical Royal Colleges, the British Medical Association's research panel and a random selection of NHS trusts across various UK regions. Participants 417 UK doctors with an equivalent split of gender (48% males) and seniority (49% consultants). Main outcomes and measures Outcomes were sleep problems (eg, insomnia), alcohol/drug use (eg, binge-drinking), ill health (eg, backache) and binge-eating (eg, uncontrollable eating). Predictor variables were occupational distress (psychiatric morbidity, burnout, job effort, work-life imbalance, coping with stress through self-blame or substances) and work factors (workplace and years practising medicine). results 44% of doctors binge-drank and 5% met the criteria for alcohol dependence; 24%-29% experienced negative emotions after overeating and 8% had a binge-eating disorder; 20%-61% had some type of sleep problem and 12% had severe/moderate insomnia; 69% had fatigue and 19%-29% experienced other types of ill health problems. The results show that occupational distress and job factors increase the odds of doctors using substances, having sleep problems, presenting with frequent symptoms of ill health and binge-eating. For example, burnout increased the risk of all types of sleep problems, eg, difficulty falling/staying asleep, insomnia (OR ≥1.344; p≤0.036). Even taking into consideration whether or not a doctor works in a hospital, the risk of health problems still rises when doctors have signs of occupational distress. Conclusion Early recognition of occupational distress can prevent health problems among UK doctors that can reduce the quality of patient care because of sickness-related absence.

Insomnia is a prevalent health complaint whose onset is precipitated by a variety of factors. There is an important need to identify and describe these factors to improve our understanding of risk factors and the natural history of insomnia. This article is aimed at identifying and describing the types of precipitating factors related to the onset of insomnia. A total of 345 patients evaluated for insomnia at a sleep-disorders clinic completed a sleep survey and underwent a semistructured clinical interview. As part of the evaluation, the specific precipitating events related to the onset of insomnia were identified. Subsequently, these factors were categorized (work-school, family, physical or psychological health, or indeterminate), and their affective valence (negative, positive, or indeterminate) was coded. The most common precipitating factors of insomnia were related to family, health, and work-school events. Sixty-five percent of precipitating events had a negative valence. These events differed with the age of onset of insomnia but not with the gender of participants. These findings are useful to identify potential risk factors for insomnia and improve our understanding of the natural history of insomnia.

Insomnia is a highly prevalent sleep disorder that regularly affects millions of people worldwide. Dissatisfaction with sleep is further defined as difficulty initiating and/or maintaining sleep or non-restorative sleep, on at least three nights per week for at least 3 months, despite adequate opportunity to sleep. Negative daytime impacts can include significant fatigue, sleepiness, poor concentration, low mood, or impaired ability to perform social, occupational or care giving responsibilities (DSM-5-2013). Insomnia is difficulty falling asleep or staying asleep, even when a person has the chance to do so (NSF-2017). This descriptive study aimed at finding out the prevalence of insomnia among college students and the factors for poor sleep. Using random sampling procedure, 50 Post graduate boys and 50 postgraduate girls who are staying in hostel were selected for the study. Insomnia Severity Index (ISI) with 5 point Likert scale (0=no problem, 4=very severe problem) developed by Charles Morin has been used measuring the sleep disorder. Results revealed that sleep disorders very much prevalent and their lifestyles such as involvement in social networking, stress and peer influence are the predominant factors causing poor sleep disorders. It also has caused poor health and fatigue. This paper emphasized the need for creating awareness on insomnia and its consequences. Constructive Life style education will enhance the wellbeing of students.

Sleep related cognitions (e.g., faulty beliefs and appraisals, unrealistic expectations, perceptual and attention bias) play an important role in perpetuating insomnia. This paper presents new psychometric data on an abbreviated version of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), a 16-item self-report measure designed to evaluate a subset of those sleep related cognitions.
Psychometric study of a patient-reported measure of sleep related beliefs based on existing clinical and research databases.
A total of 283 individuals (60% women; mean age of 46.6 years old) with insomnia, including 124 clinical patients and 159 research participants.
Participants completed the DBAS, Insomnia Severity Index, Beck Depression and Anxiety Inventories, daily sleep diaries for 2 weeks, and 3 nights of polysomnography (research sample only) as part of a baseline assessment. The DBAS-16 was found to be reliable, as evidenced by adequate internal consistency (Cronbach alpha = 0.77 for clinical and 0.79 for research samples) and temporal stability (r = 0.83). The factor structure was similar to the original 30-item version, with 4 factors emerging and reflecting: (a) perceived consequences of insomnia, (b) worry/helplessness about insomnia, (c) sleep expectations, and (d) medication. DBAS total scores were significantly correlated with other self-report measures of insomnia severity, anxiety, and depression, but not with specific sleep parameters.
The psychometric qualities of this abbreviated DBAS-16 version seem adequate. This patient-reported measure should prove a useful instrument to evaluate the role of sleep related beliefs and attitudes in insomnia and to monitor change on this cognitive variable as a potential moderator of treatment outcome.

I chose this topic for research because sleep deprivation is slowly affecting more people as each day passes and has both neurological and physical impacts. Scientists have proven again and again over the past few decades that sleep is essential for a healthy brain and even for a healthy body. Nationwide, many people are victims of sleep deprivation but students have progressively become a common subject to this phenomenon. A students’ academic performance is dependent on the mental and physical health and insomnia is a disorder which is not given the serious recognition it deserves. The need to conduct this research stands in the fact that sleep deprivation is not recognized as a disorder; and many students suffering from this issue are not only neglected but the resultant poor academic performance is blamed on lack of attentiveness in the classroom

Despite its high prevalence and burden, insomnia is often trivialized, under-diagnosed, and under-treated in practice. Little information is available on the subjective experience and perceived consequences of insomnia, help-seeking behaviors, and treatment preferences. The use of qualitative approaches (e.g., ethnography, phenomenology, grounded theory) may help gain a better understanding of this sleep disorder. The present paper summarizes the evidence derived from insomnia studies using a qualitative research methodology (e.g., focus group, semi-structured interviews). A systematic review of the literature was conducted using PsycINFO and Medline databases. The review yielded 22 studies and the quality of the methodology of each of them was evaluated systematically using the CASP appraisal tool. Selected articles possess at least a very good methodological rigor and they were categorized according to their main focus: “Experience of insomnia”, “Management of insomnia” and “Medicalization of insomnia”. The main findings indicate that: 1) insomnia is often experienced as a 24-hour problem and is perceived to affect several domains of life, 2) a sense of frustration and misunderstanding is very common among insomnia patients, which is possibly due to a mismatch between patients’ and health care professionals’ perspectives on insomnia and its treatment, 3) health care professionals pay more attention to sleep hygiene education and medication therapies and less to the patient’s subjective experience of insomnia, and 4) health care professionals are often unaware of non-pharmacological interventions other than sleep hygiene education. An important implication of these findings is the need to develop new clinical measures with a broader scope on insomnia and more targeted treatments that take into account the patient’s experience of insomnia. Greater use of qualitative approaches in future research may produce novel and more contextualized information leading to a more comprehensive understanding of insomnia.

Antecedentes: el insomnio es la alteración del sueño más frecuente en población adulta y en los últimos años se ha destacado como un importante problema de salud pública. La evidencia empírica sugiere que el insomnio se relaciona con  problemas  de  salud  mental  y  física.  Por  ello,  resulta necesario identificar e intervenir este problema y disponer de instrumentos prácticos y confiables para su evaluación. Objetivos:  analizar  las  propiedades  psicométricas  de  la versión  breve  de  la  Escala  de  Insomnio  de  Atenas  en adultos  peruanos.  Método:  participaron  367  adultos peruanos  seleccionados  mediante  muestreo  por conveniencia  y  criterios  de  inclusión.  Desde  la  Teoría Clásica de los Test (TCT) y la Teoría de Respuesta a los Ítems (TRI), se analizó las fuentes de evidencias de validez del  instrumento.  Resultados:  el  65.9%  indicó  que  tuvo dificultades para dormir durante el último mes. La escala evidencia  una  estructura  unidimensional,  aceptable confiabilidad, invarianza según el sexo y relación moderada con otra variable. Asimismo, los parámetros a y b fueron aceptables  y  la  escala  resulta  ser  más  precisa  en  niveles altos  de  insomnio.  Conclusiones:  los  hallazgos  sugieren que  la  escala  presenta  adecuadas  evidencias psicométricas  y  se  recomienda  su  uso  para  evaluar  el insomnio en población adulta peruana. [Background:  Insomnia  is  the  most  frequent  sleep disturbance  in  the  adult  population  and,  in  recent  years,  it has been highlighted as an important public health problem. Empirical  evidence  suggests  that  insomnia  is  related  to mental  and  physical  health  problems.  Therefore,  it  is necessary  to  identify  and  intervene  in  this  problem  and have  practical  and  reliable  instruments  for  its  evaluation.
Objectives: To analyze the psychometric properties of the short  version  of  the  Athens  insomnia  scale  in  Peruvian adults. Method: Three hund red sixty-seven (367) Peruvian adults  selected  by  convenience  sampling  and  inclusion criteria participated in the study. Based on the classical test theory  (CTT)  and  item  response  theory  (IRT),  the  sources of  validity  evidence  of  the  instrument  were  analyzed. Results: Sixty-five point nine percent (65.9%) of the study population indicated that they had difficulty sleeping during the  last  month.  The  scale  evidences  a  one-dimensional structure, acceptable reliability, invariance according to sex and moderate relationship with another variable. Likewise, parameters a and b were acceptable, and the resulting scale was more accurate at high levels of insomnia. Conclusions: The  findings  suggest  that  the  scale  presents  adequate psychometric  evidence,  and  its  use  is  recommended  to evaluate insomnia in the Peruvian adult population.]

Sleep and insomnia are anthropological constants and recurring themes in discourses about creativity and scholarship since antiquity. Kafka's personal and fictional writings are part of this discursive tradition. This article explores the complex interplay between insomnia and (in)attention in Kafka's texts, with a focus on his last novel, Das Schloss (The Castle).

In reading E.M. Cioran’s œuvre, one is faced with an immediate and unremitting abrasiveness that has its roots with our being born into time. Indeed, the author of The Fall into Time and The Trouble with Being Born thought that it is precisely this accidental and unredeemable temporality, an original sin that results in a life forever situated in cycles of striving and becoming, which is to be exhuastingly apprehended in the experience of boredom: ‘Life is more and less than boredom, though it is in boredom and by boredom that we discern what life is worth.’ Cioran’s pessimism never relents; even his lugubrious friend Samuel Beckett had to keep his distance after finding him ‘too pessimistic’—who else but Cioran could write that ‘leukemia is the garden where God blooms’? Despite this, in Cioran’s often autobiographical, aphoristic and essayistic writings, we find a richly-timbred boredom (ironically so) which gives us incisive observations into a multitude of related concepts and realities. Nothingness, God, silence, mysticism, suffering, and quietism (among others) all feature in Cioran’s writings on boredom, as well as in this paper’s attempt to better situate Cioran’s work with respect to his more famous pessimistic and existentialist relations’s take on the subject, namely Arthur Schopenhauer and Martin Heidegger. In exploring his work on boredom vis-à-vis specific writings on mysticism, Taoism, nothingness, time and insomnia, this paper aims to show how the failure to attain what Cioran called ‘a grain of ataraxy’, necessarily presupposes a limited set of ‘possibilities’ and ‘prospects’ when faced with the experience of ‘the sensation of the emptiness of existence’ that is boredom (Schopenhauer).

Abstract

The primary goal of this study is to state the clear changes in functional brain connectivity during all night sleep in psycho-physiological insomnia (PPI). The secondary goal is to investigate the usefulness of Mutual Information (MI) analysis in estimating cortical sleep EEG arousals for detection of PPI. For these purposes, healthy controls and patients were compared to each other with respect to both linear (Pearson correlation coefficient and coherence) and nonlinear quantifiers (MI) in addition to phase locking quantification for six sleep stages (stage.1-4, rem, wake) by means of interhemispheric dependency between two central sleep EEG derivations. In test, each connectivity estimation calculated for each couple of epoches (C3-A2 and C4-A1) was identified by the vector norm of estimation. Then, patients and controls were classified by using 10 different types of data mining classifiers for five error criteria such as accuracy, root mean squared error, sensitivity, specificity and precision. High performance in a classification through a measure will validate high contribution of that measure to detecting PPI. The MI was found to be the best method in detecting PPI. In particular, the patients had lower MI, higher PCC for all sleep stages. In other words, the lower sleep EEG synchronization suffering from PPI was observed. These results probably stand for the loss of neurons that then contribute to less complex dynamical processing within the neural networks in sleep disorders an the functional central brain connectivity is nonlinear during night sleep. In conclusion, the level of cortical hemispheric connectivity is strongly associated with sleep disorder. Thus, cortical communication quantified in all existence sleep stages might be a potential marker for sleep disorder induced by PPI.
Discussion and conclusion
In the present study, four hemispheric connectivity measurements were examined to obtain the electrophysiological arousals on sleep EEG epoches recorded from healthy controls and patients with PPI. All individuals can be classified correctly by using any data mining classifier for both entropy based MI estimations and spectral connectivity measurement so called coherence created by Welch’ method. When the Burg method was performed to compute the power spectral density estimation of sleep EEG epoch in estimating coherence, error free classification can be obtained by using only three classifiers (RBFNetwork, NNge, SMO). Regarding as PCC estimations, one person was misclassified in all classifiers. Concerning phase coherence estimations, one or two individuals were always misclassified.

In particular, lower interhemispheric coherence and lower MI estimations as well as higher PCC values were provided by patients in comparison to controls. In fact, only linear relations between particular hemispheric locations could be observed by using coherence, whereas the MI can measure both linear and nonlinear statistical dependencies of hemispheres in time domain. The results support that the cortex becomes more inactive as the sleep stage goes through from one stage to the next one in non REM sleep periods (stage.1–4), however, the cortex becomes much more active. It means that more neurons will be active in processing the information transmission during REM sleep in REM sleep periods. The higher order statistics of time series can be represented by nonlinear approaches, regarding as the information theory [7]. Therefore, the MI provided the most useful estimations.

The MI can give information in the context of functional connectivity such that its value highly depends on the accuracy of estimated JE derived from probability distribution. The results revealed that temporal dependency of cerebral hemispheres by means of MI can provide a very efficient tool for detection of PPI from sleep EEG recordings. The MI is a measure of statistical dependence between two random time series without making any assumption on the nature of these signals. Since, the duration of each single epoch was long enough, MI estimations gave stable estimates. Another factor making the MI be successful in detecting hemispheric functional changes between controls and PPI is that sleep EEG series are narrow band signals as stated in reference [4].

In the further study, the relationship between sleep stages and information transmission of multi-channel EEG measurements in controls will be investigated. Additionally, MI will be used to analyze sleep EEG series in detecting the effects of mood disorder depending on functional disorganization of the brain.

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Tahukah anda, apakah Hipersomnia? Istilah medis ini dalam bahasa mudahnya, kantuk yang sangat. Bisa dibilang kebalikan dari sulit tidur (insomnia). Penyebab Hipersomnia bisa bervariasi, seperti konsumsi obat-obatan kimia, bekerja tak kenal waktu, ketidak bahagiaan dalam keluarga, atau masalah sosial. Masalah kesehatan ini pada dasarnya bisa diatasi dengan mengatur pola hidup.

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases (Cochrane, CINAHL, EBSCOhost, EMBASE, Google Scholar, MEDLINE, ProQuest Medical, PsycINFO, ScienceDirect, Scopus, and Web of Science) and six preprint repositories were searched for the period From November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups. More research is needed to establish the courses of sleep disturbances over time in various populations.

Purpose: This article focuses on recent evidence linking Rapid eye movement (REM) obstructive sleep apnea (OSA) (REM-OSA) to neurocognitive dysfunction and mood changes, the proposed mechanisms for increased risk of neurocognitive dysfunction in REM-OSA, and future research prospects.

Methods: PubMed and Google Scholar records were examined for articles utilizing predefined keywords. In this work, we mainly included studies published after 2017; nevertheless, critical studies published prior to 2017 were considered.

Results: REM-OSA is an under-recognized stage-related sleep-disordered breathing in which obstructive respiratory events happen chiefly in stage REM. The disorder is commonly seen amongst younger patients and females and has recently been linked to cardiometabolic complications. Although less symptomatic than non-REM-OSA and non-stage-specific OSA, current findings indicate that REM-OSA may have neurocognitive repercussions and mood changes and could be linked to insomnia, increased dreams, and nightmares.

Conclusion: Currently available evidence indicates that REM-OSA may present with insomnia and nightmares and could affect cognitive function and mood.

Insomnia is a conspicuous problem in modern 24 h society. In this brief overview, medications used to treat insomnia such as hypnotics, sedatives, medications inducing sedation as a side effect, medications directed at the sleep-associated circadian neuroendocrine system, and agents utilized in treating insomnia-inducing sleep diagnoses such as restless leg syndrome are discussed. The newer GABA-effective hypnotics are the only medications with demonstrated effectiveness in treating chronic insomnia with the majority of evidence supporting treatment efficacy for cognitive-behavioral therapy and short acting GABA-receptor agonists. In patients with comorbid insomnia the use of hypnotics can improve outcomes and potentially reduce morbidity and mortality associated with the use of more toxic medications. Except in individuals whose insomnia is secondary to circadian disturbance, mood disorder/depression and/or restless leg syndrome , there is minimal evidence supporting the efficacy of other medications used to treat insomnia despite their widespread use. Sedatives and other medications used off-label for sedative side-effects are a contributing factor to drug induced hypersomnolence, a factor in more than 30% of motor accident deaths. Hypnotic medications with low toxicity, addictive potential, minimal next day sleepiness, and an otherwise benign side-effect profile can be utilized safely and effectively to treat and improve function and quality of life for patients suffering from insomnia. These are the agents that should be exclusively classified as hypnotics and utilized to induce sleep when medications are required to treat the complaint of insomnia. Other pharmacological agents producing sedation (sedatives and agents used off-label for sedative side-effects) should be used cautiously for the treatment of insomnia due to the increased risk of next day sleepiness as well as for known toxicities and adverse side effects.

Il semble que près de 35 % de la population adulte signale des troubles de sommeil durant l’année et que 10 % de la population générale souffrirait d’insomnie chronique. Les conséquences de l’insomnie sont nombreuses et néfastes pour le patient. En effet, 40 % des gens souffrant d’insomnie non traitée risquent de souffrir d’une dépression majeure durant l’année qui suit. De plus, dans de 35 % à 40 % des cas, l’insomnie est associée à un trouble de l’humeur, à de l’anxiété ou à un problème de dépendance ou d’alcoolisme.

Background and Objective: Insomnia is one of the most prevalent sleep-related problems among university students. To date, several explanatory models for insomnia have been presented; however, the perspective of procrastination has been less considered. The present study's aim was to determine the association between procrastinatory cognitions and bedtime procrastination, and insomnia among students. Materials and Methods: The present study was a cross-sectional study. The study population consisted of students of Zanjan University of Medical Sciences, Zanjan, Iran. A total of 433 students were selected using stratified random sampling method. Data were collected using the Insomnia Severity Index (ISI), Bedtime Procrastination Scale (BTPS), and Procrastinatory Cognitions Inventory (PCI). Results: The severity of insomnia in medical students varied from non-clinical to clinical insomnia. In addition, the results of regression analysis indicated that the full model was significant regarding the predictors of insomnia. Only 3% of variance in insomnia severity was due to demographic variables, while bedtime procrastination and procrastina-tory cognitions explained 33% of the variance in the severity of insomnia among students. Conclusion: The procrastination-related structures such as procrastinatory cognitions and bedtime procrastination play an important role in explaining insomnia in students. Addressing these variables as perpetuating factors can be considered in the treatment of insomnia in students.

Stress is considered to be an important cause of disrupted sleep and insomnia. However, controlled and experimental studies in rodents indicate that effects of stress on sleep–wake regulation are complex and may strongly depend on the nature of the stressor. While most stressors are associated with at least a brief period of arousal and wakefulness, the subsequent amount and architecture of recovery sleep can vary dramatically across conditions even though classical markers of acute stress such as corticosterone are virtually the same. Sleep after stress appears to be highly influenced by situational variables including whether the stressor was controllable and/or predictable, whether the individual had the possibility to learn and adapt, and by the relative resilience and vulnerability of the individual experiencing stress. There are multiple brain regions and neurochemical systems linking stress and sleep, and the specific balance and interactions between these systems may ultimately determine the alterations in sleep–wake architecture. Factors that appear to play an important role in stress-induced wakefulness and sleep changes include various monominergic neurotransmitters, hypocretins, corticotro-pin releasing factor, and prolactin. In addition to the brain regions directly involved in stress responses such as the hypothalamus, the locus coeruleus, and the amygdala, differential effects of stressor controllability on behavior and sleep may be mediated by the medial prefrontal cortex. These various brain regions interact and influence each other and in turn affect the activity of sleep–wake controlling centers in the brain. Also, these regions likely play significant roles in memory processes and participate in the way stressful memories may affect arousal and sleep. Finally, stress-induced changes in sleep-architecture may affect sleep-related neuronal plasticity processes and thereby contribute to cognitive dysfunction and psychiatric disorders.

Objective: The aim of this research was to examine validity and reliability of the Turkish version of the Bergen Insomnia Scale (BIS) in adolescents. Methods: The scale was applied to a total of 1293 adolescents and 110 students were retested four weeks later. While content and construct validity analyses were carried out for validity of the scale, internal consistency and test-retest analysis was used for the reliability. Content validity of the scale was evaluated by opinions from 10 experts, construct validity via confirmatory factor analysis, internal consistency via Cronbach's alpha reliability coefficient, test-retest results via Pearson's correlation analysis. Results: Cronbach's alpha reliability coefficient of Bergen Insomnia Scale was found as 0.72. Item-total correlations were ≥0.36 and test-retest correlation was 0.74. Content validity index was found to be 99%, there was agreement between experts, the items in the scale were suitable for our culture, and it represented the structure which was intended to be measured. Confirmatory factor analysis confirmed the structure of BIS consisting of 6 questions and 2 factors. Conclusion: Bergen insomnia scale was found to be reliable and valid. The scale can be used to measure insomnia in Turkish adolescents.

Obstructive sleep apnea (OSA) is a breathing-related sleep disorder that is associated with substantial morbidity and disturbing quality of life. It is a systemic disorder that is associated with a wide range of comorbid abnormal behavioral symptomatology. OSA usually presents with snoring, daytime sleepiness, and choking attacks during sleep. However, the disorder may present with unusual presentations such as behavioral, psychiatric, and neurocognitive abnormalities, or abnormal movements disorders during sleep. Additionally, OSA may worsen comorbid psychiatric and behavioral disorders. Therefore, it is imperative for healthcare providers to have the knowledge and clinical skills to recognize the unusual presentation of OSA, particularly, changes in behavior, and to recognize the interaction between OSA and its comorbidities, which may affect behavior. This chapter discusses the association between OSA and psychiatric and behavioral disorders, which may influence the presentation of OSA.

The factor structure of the Insomnia Severity Index (ISI) is discussed, with examples being drawn from about 13 disparate reported models. A systematic appraisal of procedural details of studies investigating the dimensionality of the ISI was performed. The databases CINAHL, Cochrane Library, Embase, Medline, and PsycINFO were searched thoroughly, and all articles in English, published, and/or available online as of 14th March 2019, were included. Meta-analyses of Cronbach's alpha and structural validity measures were performed. Several inadequacies or omissions were found in analyses using the three groups of measures. Fifteen out of 20 studies did not employ either EFA or CFA, 10 studies did not report CFA, while five did not report EFA. The most common omissions related to multivariate normality, final model selection based on consideration of fit indices, parsimony, and failure to consider the theoretical construct in the final model selection. Meta-analysis showed that CFA outcome is more robust compared to EFA, two-factor solution is the vigorous presentation of dimensionality compared to a three-factor solution, and ISI has a high pooled Cronbach's alpha. Further validation of the disparate models of the ISI is needed with more comprehensive reporting guidelines, such as the one suggested in the present review.

Objective: Insomnia and reduced heart rate variability (HRV) increase the risk of cardiovascular disease and its precursors; thus, it is important to evaluate whether treatment for insomnia provides cardiovas-cular safeguards. The present study aimed to evaluate potential cardiovascular benefits of cognitive behavioral therapy for insomnia (CBT-I). Method: The present study included 65 patients treated for chronic insomnia (M 51.8 years, SD 10.0; 66.2% female) at a university hospital. Patients received CBT-I over a 6-week period, and change scores from pre-to posttreatment derived from the Insomnia Severity Index, sleep diary, and polysomnography (PSG) were used as indices of sleep improvement. HRV variables (i.e., low frequency [LF], high frequency [HF], and the ratio of low to high frequency [LF:HF ratio]) were derived for Stage 2 (S2) and rapid-eye movement (REM) sleep at pre-and posttreatment. High HF (i.e., parasympathetic activity) and/or low LF:HF ratio (i.e., sympathovagal balance) were used as indices of HRV improvement. Results: Following therapy, sleep improvements, particularly for sleep onset latency, were related with reduced HF in S2 (r .30, p .05) and in REM (r .36, p .01). A trend was also observed between reduced insomnia symptoms and increased HF in REM (r .21, p .10). Conclusions: Findings suggest that contrary to expectations, sleep improvements following CBT-I were associated with reduced parasympathetic activation and increased sympathovagal balance. Although preliminary, these results raise the question as to whether insomnia treatment might play a role in physiological changes associated with cardiovascular anomalies. Future research is needed to examine the long-term impact of treatment as a preventative tool against insomnia-related morbidity.

The purpose of this study was to develop a new technological meditative tool, called the virtual reality meditative technique (VRMT) and test its feasibility for further large-scale studies. This VRMT was designed by the 7D Health research team based on principles of mind-body medicine, mental imagery, meditation, and other mystical states of consciousness to promote health-producing effects and optimal well-being. A sacred Hindu virtual reality (VR) environment was created for Hindu participants. EEG equipment was used to detect brainwave changes throughout the virtual reality experience, and self-report measures were administered to gather qualitative data. Although the sample size for this pilot study was too small for statistical data analysis, there were some observed brainwave changes, which suggest that some of the participants were experiencing shifts of consciousness. Additionally, the self-report data revealed that several participants felt calm, peaceful, and compassionate, with some experiencing improved moods. These results demonstrate the need for a further large-scale study to explore the wide range of health possibilities that this new technique could offer as a meditative aid. This VRMT intervention could have potentially therapeutic implications for complementary medicine, improving a person's well-being, as well as for enhancing one's creativity, training compassion, developing a high performance mind, and quickly experiencing higher states of mystical consciousness. Utilisation de la Réalité Virtuelle pour une Neuro-technologie Méditative (Étude Pilote) Par Ranjie Singh, Ph.D., Paula Rayo et Nirvana Singh Résumé Le but de cette étude était de développer un nouvel outil technologique, appelé la « technique méditative de réalité virtuelle » (VRMT d'après ses initiales en anglais) et de mettre à l'épreuve sa faisabilité afin de pouvoir poursuivre ultérieurement des études à grande échelle. Cette VRMT a été conçue par l'équipe de recherche de santé « 7D » et se base sur les principes de la médecine corps-esprit, l'imagerie mentale, la méditation et d'autres états mystiques de conscience, avec le but de promouvoir des effets générateurs de santé et de bien-être optimal. Un environnement de réalité virtuelle (VR) hindoue sacrée a également été créé à l'attention des participants de nationalité hindoue. Un équipement de EEG (électro-encéphalogramme) a été utilisé afin de détecter des changements dans les ondes cérébrales tout au long de l'expérience de réalité virtuelle, et des tests d'auto-évaluation ont été fournis afin de recueillir des données qualitatives. Bien que la taille d'échantillon de cette étude pilote ait été trop exiguë pour produire une analyse