Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea:A retrospective,nonrandomized controlled study

Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms,advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users.However,residual insomnia symptoms persisted,indicating that PAP therapy provides only limited treatment.RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes,and their potential impact on posttraumatic stress symptoms.Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.

Insomnia Symptoms and Sleep Duration Are Associated with Impaired Cardiac Autonomic Modulation in Children

Limited population-based data from children are available to investigate the associations between insomnia and sleep duration in relationship to impaired cardiac autonomic modulation (CAM). Therefore, the objective of this study is to examine the cross-sectional associations between insomnia symptoms, sleep duration, and CAM in a population-based sample of children. All 616 children were randomly selected from Central Pennsylvania to participate in a one-night polysomnography (PSG) study in a sleep laboratory. The Pediatric Behavior Scale was used to assess parent-reported insomnia. Sleep duration was assessed objectively by PSG. CAM was measured by heart rate variability (HRV) analysis of 9-hour-beat-to-beat RR intervals. Multivariate linear regression models were used to assess the association between insomnia, sleep duration and HRV. The mean (SD) age was 9.2 (1.7) years, with 25.5% non-white and 48.9% male. After adjusting for age, race, gender, BMI percentile, %REM sleep, apnea-hypopnea-index, sleep latency, and sleep efficiency, the means(SE) of HRV indices were lower in children with insomnia than in children without: 6.56 (0.07) vs. 6.78 (0.04) m2 on logHF, respectively;and 6.47 (0.06) vs. 6.61 (0.03) m2 on logLF, respectively (all P < 0.05). There is a trend towards a significant lower time domain HRV indices, faster HR, and higher LF/HF ratio in children with insomnia symptoms. There is a similar pattern of association between shorter objective sleep duration and HRV. Insomnia symptoms and shorter objective sleep duration are associated with lower HRV and higher HR and LF/HF ratio, indicative of disturbance of CAM towards more sympathetic and lower parasympathetic modulation. These data provide supporting evidence of physiological activation associated with insomnia and short sleep duration even in very young children.

Level of Insomnia, Symptoms of Depression, and Anxiety among College Students with Mobile Phone Addiction: Basis for Guidance and Counseling Program Enhancement

Mobile phone addiction is a growing concern among college students, with significant implications for their mental health. This study examines the complex relationship between mobile phone addiction and its impact on college students’ insomnia, symptoms of depression, and anxiety. A sample of 399 college students from traditional Chinese medicine colleges in Guangxi, China, completed the Mobile Phone Addiction Tendency Scale questionnaire. Among them, 155 students with high Mobile Phone Addiction Tendency scores were selected for the correlation study. The analysis revealed a strong association between mobile phone addiction and insomnia. Furthermore, mobile phone addiction was significantly associated with symptoms of depression, including feelings of sadness, worthlessness, and hopelessness, as well as heightened anxiety symptoms, such as excessive worry and restlessness. These findings emphasized the importance of targeted interventions and preventive measures to address the negative impact of mobile phone addiction on college students’ mental health.

Assessment of the Effect of “3H” Nursing Mode on Negative Emotions and Insomnia in Patients with Enterostomy

Objective: To explore the clinical significance of “3H” nursing mode in improving negative emotions and insomnia in patients with enterostomy through a prospective cohort study. Methods: Adult patients who underwent enterostomy surgery in our gastroenterology department with negative emotions and insomnia between August 2021 and August 2022 were selected as research objects and randomly divided into “3H” nursing mode group and conventional nursing management group. For the conventional nursing group, routine standard nursing mode was adopted after enterostomy, while extra systematic “3H” nursing service on the basis of conventional nursing management was applied for its counterpart. SAS and SDS scores, Pittsburgh sleep quality index, Barthel index and nursing satisfaction were compared between the two groups. Results: SAS and SDS scores, Pittsburgh sleep quality index, Barthel index and nursing satisfaction of “3H” nursing mode group were evidently better than those of conventional nursing management group, and the difference was significant (P Conclusion: The “3H” nursing mode can effectively improve negative emotions of patients with enterostomy, such as anxiety and depression, improve their sleep quality and self-care ability in daily life, and play an important role in building a harmonious relationship between doctors and patients, nurses and patients, which is worthy of clinical application.

Treating Comorbid Insomnia in Older Adults via Cognitive-Behavioural Treatment, Bright Light and Exercise

Background: Insomnia occurs frequently in older adults. The underlying factors for the disorder are physiological changes of the sleep-wake cycle, comorbid diseases and drug treatment. Cognitive behavioural therapy (CBT I) combined with light therapy and physical activity can be effective in the treatment of comorbid insomnia in older adults. Methods: Sixty-three (63) insomnia patients (47 female, 16 male) with an average age of 66.6 years participated in the program. Before and after the treatment, the participants completed questionnaires to assess their sleep quality (PSQI), day-time sleepiness (ESS), mood (BDI) and well-being (WHO-5-Index). In addition, they kept sleep diaries for six weeks. Results: Pre-post comparisons revealed a significant improvement in sleep latency and sleep quality, as well as a significant reduction of day-time sleepiness. In patients with both insomnia and depression, all depression scores improved slightly but significantly. Conclusions: Non-pharmacological combination treatment using CBT I, light therapy and physical activity seemed to be effective in older adults with comorbid insomnia and improve additionaly depressive symptoms.

The Somnogen Visual Training a New CBT to Fight Insomnia through Closed Eyes and fNIRS Neuroimaging

The use of a red light observed through closed eyes is a new CBT Cognitive Behavioral Therapy to fight insomnia. Its principles are based on the high transmission of the colour red through eyelids, the great sensitivity to light of the retina when it is adjusted to darkness and the mental distraction obtained by the perception and attentive observation of variations of intensity. The prefrontal and occipital fNIRS recordings document this method which is correlated to the sleep EEG state II.

Relationship of nocturnal concentrations of melatonin, gamma-aminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke： study protocol for a prospective non-randomized controlled trial

Melatonin and gamma-aminobutyric acid（GABA） have been shown to regulate sleep. The nocturnal concentrations of melatonin, GABA and total antioxidants may relate to insomnia in stroke patients. In this prospective single-center non-randomized controlled clinical trial performed in the China Rehabilitation Research Center, we analyzed the relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke. Patients during rehabilitation of stroke were recruited and assigned to the insomnia group or non-insomnia group. Simultaneously, persons without stroke or insomnia served as normal controls. Each group contained 25 cases. The primary outcome was nocturnal concentrations of melatonin, GABA and total antioxidants in peripheral blood. The secondary outcomes were Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire（Chinese version）, and National Institute of Health Stroke Scale. The relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke was analyzed and showed that they were lower in the insomnia group than in the non-insomnia group. The severity of stroke was higher in the insomnia group than in the non-insomnia group. Correlation analysis demonstrated that the nocturnal concentrations of melatonin and GABA were associated with insomnia after stroke. This trial was registered at Clinical Trials.gov, identifier： NCT03202121.

The Therapeutic Role of Guided Mental Imagery in Treating Stress and Insomnia: A Neuropsychological Perspective

Excessive distress and insomnia are much too common in the modern world and often lead to a myriad of detrimental effects including loss of cognitive ability and even physical ailments such as cancer. Current pharmaceutical treatments can be addictive, detrimental to health, and in the case of insomnia don’t produce naturalistic sleep. We present a viewpoint on a potential adjunctive treatment of distress and insomnia that harnesses specific mental imagery as a component of mind/body relaxation technique. Via our perspective on the modern nature of stress and insomnia, our theoretical perspective on how specific guided mental imagery can be used to treat these ailments, and our review on the current literature on treatment with mental imagery, we hope to stimulate further research into mental health treatment with mental imagery which has traditionally been neglected. This perspective on the pathology of insomnia and distress is founded in prevailing “dysevolution” and hyper-arousal theories. Hyper-arousal is characterized in part by a vicious cycle of chronic physiological and emotional stimulation/distress. We argue for spatially based mental imagery in the form of nighttime-sky imagery to attenuate such pathology by breaking one away from a vicious cycle of stimulation and distress and discuss neuropsychological bases for its potential treatment mechanisms which include the autonomic nervous system and a phenomenal foundation of conscious cognition.

Treating Insomnia in Older Adult Patients: Limiting Benzodiazepine Use

As aging comes, an increased prevalence of medical maladies and chronic pain independently or interactively disrupt sleep, which in turn can exacerbate either one. Furthermore, anxiety about pain can further negatively impact sleep. Fortunately, good quality sleep can improve pain management. Because benzodiazepine receptor agonists (including the “Z” drugs) can reduce anxiety and improve sleep, they seem a convenient choice. However, their use in this population, particularly for more than short-term (guidelines range from 2 to 6 weeks max), is not recommended because of increased likelihood of falls, further disruption of sleep, dependence, and problems with discontinuation (withdrawal). Besides, this population is often likely to take concomitant medication for pain or other central nervous system depressants leading to potentially serious and even life-threatening interactions involving synergistic amplification of respiratory depression (opioids being a particularly dangerous interaction). Therefore, insomnia in older adults should ideally be treated with a non-benzodiazepine receptor agonist;if indicated, they may be used, but should be closely monitored and tapered to avoid long-term adverse problems (direct or from withdrawal). Older adult patients with insomnia may be more optimally treated with sleep aids that do not interact with the GABAA receptor.

Changes in cognitive function in patients with primary insomnia

背景:原发性失眠患者是否存在认知功能损害,其神经心理学的证据仍不充分,需要作进一步研究。目的:探讨原发性失眠患者认知功能改变及其影响因素。方法:对40例失眠患者(失眠组)和48例正常睡眠者(对照组)进行匹兹堡睡眠质量指数(Pittsburgh SleepQ uality Index,PSQI)、情景记忆测试和蒙特利尔认知评估(Montreal cognitive assessment,MoC A)测验。结果:失眠者MoC A测试的总分(t=3.24,p=0.002)、命名(t=3.17,p=0.002)成绩较对照组差,即刻记忆(t=3.33,p=0.001)、延迟回忆(t=6.05,p=0.001)成绩较对照组差。不同失眠程度的被试在命名(F=7.56,p=0.001)、语言(F=3.22,p=0.045)、总分(F=6.72,p=0.002)、延迟记忆(F=8.41,p=0.001)、延迟回忆(F=22.67,p=0.001)差异显著。且原发性失眠患者的年龄与MoC A总分、即刻记忆、延迟回忆和延迟再认功能相关有统计学意义,受教育年限与MoC A总分、视空间与执行功能、命名、注意、语言、抽象等功能相关有统计学意义。结论:原发性失眠患者存在认知功能损害;且失眠程度越严重,认知功能损害范围越广,程度越重。

中医药治疗失眠研究简况

失眠不是一个单纯简单疾病,单纯控制症状,即使指标改善,也难以达到治疗目的。中药治疗:虚证,扶阳抑阴、运转枢机-乌菟汤、十味温胆汤、归脾汤;火扰心神-大补阴丸、二阴煎、龙胆泻肝汤、丹栀逍遥散、黄连温胆汤、六味地黄丸;痰浊上犯,阻遏心窍,扰动心神-温胆肠加枣仁;瘀阻脉络,心失所养,失眠胶着难愈-血府逐瘀汤、逐瘀安神汤;失眠与情志变化最为相关,情志抑郁-逍遥散、柴胡加龙骨牡蛎汤。辅助疗法有针灸、耳针、耳穴压豆、埋线、推拿按摩等。中医药治疗可规避西药缺点,经验总结多,创新治疗方式及手段、新理念少。国外针灸、耳针研究多单纯、片面、表浅及固化,缺乏辨证论治理念。针灸及相关辅助疗法无毒副作用,更适用原发性失眠及顽固性失眠;耳针效果微弱,穴位埋线效果及持效程度优于体针。临床离不开辨证论治,应重调理轻指标,重治本轻治标;治疗原发疾病,辅以抗失眠类中药调理效果更佳;针药结合为未来主攻方向,既有利于原发疾病治疗,又可规避药物毒副作用,减轻耐受性、依赖性及反跳现象。

Insomnia in Patients Suffering from Chronic Medical Illnesses: Prevalence and Impact of IAYT

Background: Sleep is an important lifestyle factor to be addressed in patients having chronic non-communicable diseases. Data revealing prevalence of insomnia in chronic medical illnesses (CMIs) in Indian population are lacking. Yoga has been found effective in improving sleep quality in patients with chronic medical illnesses (CMIs). Aim: To find the prevalence of insomnia in major chronic medical illnesses and to assess the effect of Integrated Approach of Yoga Therapy (IAYT) on them. Methods and Material: From the outpatients and inpatients of our integrative therapy clinics, 200 patients (116 males;84 females) in the age range 49.57 ± 11.71 years, who satisfied the inclusion criteria and were diagnosed by the physician with any of the four major categories of CMIs: cardio-pulmonary, diabetes, musculoskeletal, and psychiatric were screened for insomnia using Insomnia Severity Index (ISI) scale. Those found suffering from clinically significant insomnia (ISI score > 14) were admitted and a residential IAYT intervention was given for a week. Before and after the intervention, ISI and Pittsburg insomnia rating scale (PIRS) were administered to assess extent of insomnia. Data was analyzed before and after the intervention using paired t-test. Results: Taking all patients of CMIs together, we found that 35% suffered from clinical insomnia, out of which, 12.5% had severe and 22.5% had moderate insomnia. We also found that prevalence of clinical insomnia was highest among those suffering from psychiatric illnesses (62.07%) and minimum in those having musculoskeletal disorders (28.05%). Those suffering from diabetes mellitus and cardio-pulmonary disorders reported prevalence of 32.25% and 31.94% respectively. After IAYT intervention of one week, extent of clinical insomnia reduced from 35% at the baseline to 8.5% in all patients of CMIs taken together. Following changes were observed in percentage of patients suffering from clinical insomnia in different CMIs before and after one week of IAYT intervention: 1) In psychiatric patients, the percentage reduced from 62.07% to 24.13%;2) In diabetic patients, the percentage reduced from 32.27% to 3.0%;3) In patients having musculoskeletal disorders, the percentage reduced from 28.05% to 8.53%;and 4) In patients having cardio-pulmonary illnesses, the percentage reduced from 31.94% to 2.7%. Conclusion: Prevalence of insomnia is higher in patients suffering from chronic medical illnesses. IAYT intervention of one week may be helpful in reducing extent of insomnia in this population.

Electroencephalographic Abnormalities in Patients with Idiopathic Insomnia

Objective: The main goal of the present research is to describe the electroencephalographic activity during sleep and the cyclic alternating pattern (CAP) on idiopathic insomniac patients. Methods: 22 idiopathic insomnia patients were included. Sleep recording included: fully conventional EEG recording (32 electrodes, with 16 channels getting ipsilateral bipolar recordings), EOG, EMG, EKG, thoracic and abdominal respiratory movements, nasal flow and oximetry. Results: Out of the 22 registered patients, 10 (45%) showed no electroencephalographic alteration, while 12 (55%) exhibited an electroencephalographic alteration (irritative activity). Concerning PSG variables, significant differences between groups (no EEG alteration and EEG alterations) were detected in: sleep latency, total sleep time, total wake time, sleep efficiency, light sleep percentage, slow waves sleep percentage and on the sub type A1 index of the cyclic alternant pattern CAP. Conclusions: The present data strongly suggest that within the population diagnosed with idiopathic insomnia, there is a subgroup in which the electroencephalographic alterations may play a critical role as the source of the sleep abnormality.

A Case of Refractory Insomnia Responding to Modified Electroconvulsive Therapy

A 42-year-old female patient suffered refractory insomnia. A variety of drugs including anti-anxiety, antidepressants, antipsychotics and repetitive transcranial magnetic stimulation (rTMS) have been applied in the treatment with no significant effect, whereas modified electroconvulsive therapy (MECT) can significantly improve the patient’s sleep.

INSOMNIA TREATED WITH AURICULAR-PLASTER THERAPY IN 218 CASES

218 cases of insomnia were treated by auricular plaster therapy with seeds of Vaccaria segetalis. The auricular points Heart, Shenmen, Occiput and Brain were selected. The resultsshowed that 136 cases were cured, 76 markedly impr0ved and 6 no effect. The effect of this therapywas significantly better than that of medication (P【0. 01) in comparison with the application of western medicine.

慢性失眠病人脑内神经递质活动的超慢涨落图表现

目的:探讨慢性失眠病人脑内神经递质活动变化。方法:用WF92型脑电超慢涨落分析仪,通过检测慢性失眠病人和正常人的脑电超慢涨落图(EFG),分析其谱线变化来反映脑内神经递质活动变化。结果:慢性失眠病人51例与51例健康人配对对照比较,EFG神经递质谱系S1和S2显著降低(配对t检验,P<0.01),S3、S4、S5、S7和S11两组间比较无明显差异,提示慢性失眠病人脑内神经递质谱系S1γ氨基丁酸(GABA)和S2谷氨酸(Glu)活动存在异常,S3乙酰胆碱受体(AchR)、S45羟色胺(5HT)、S5乙酰胆碱(Ach)、S7去甲肾上腺素(NE)和S11多巴胺(DA)活动无明显变化。结论:脑内神经递质GABA和Glu活动异常可能参与了慢性失眠的发病。

Preferences for behavioral therapies for chronic insomnia

Purpose: The purpose of this study was twofold: to examine the acceptability and preference for the two behavioral therapies, and to identify factors persons with chronic insomnia take into account when choosing treatment. Methods: The data were obtained in a large trial evaluating the effects of Stimulus Control and Sleep Restriction therapies. Prior to treatment, participants completed the treatment acceptability and preference (TAP) questionnaire, which described the Stimulus Control Therapy and the Sleep Restriction Therapy and requested participants to rate the acceptability of each treatment option before choosing one for the management of chronic insomnia. Open-ended questions were used to explore the factors that participants considered when making a choice. Results: Participants rated the Sleep Restriction Therapy as acceptable and 70.2% of participants preferred it over Stimulus Control Therapy. The factors that influenced participants’ choice related to the familiarity, previous personal experience, novelty, and suitability of the treatment. Conclusion: Persons have expressed a preference for treatments to manage chronic insomnia. Healthcare providers are in a position to provide relevant information about treatment options in order to help persons make informed treatment related decisions.

Insomnia Fighting with Red Led Pulsations

This study shows how and why luminous red pulsations can distract the mind and facilitate sleep by preventing disruptive thoughts and memories. The rgb LED produces a miniature dusk-to-dawn flight device to pass from red at night to white at dawn, potentially followed by luminotherapy. Combined in a single portable device, these luminous parameters are useful in the fight against insomnia through cognitive behavioral therapy CBT.

Development of an Infusion Based on Romaine Lettuce and Banana for Treating Insomnia

An infusion was developed based on green romaine lettuce leaves and banana. Further, its sensorial acceptability was evaluated as a possible alternative treatment for insomnia. The romaine lettuces and bananas used were washed, chopped, dehydrated and ground. Optimal lettuce dehydration time was determined through charting the weight lost and examining the curve. This was found after 180 minutes at 60°C. Two formulas were developed, the first with 1.1 g of dehydrated romaine lettuce and 0.2 g of dehydrated banana, and the second with 1.1 g of dehydrated romaine lettuce and 0.4 g of dehydrated banana. Sensory analysis was conducted using sorting tests for taste, aroma, paired preferences and intention to purchase. Tasters preferred the formula with a lower quantity of dehydrated banana. 85% of tasters indicated that they would buy this infusion due to its potential functional properties for overcoming insomnia.

Perceived Stress, Anxiety and Insomnia among Nursing Staff in Saudi Arabia during the 2019 Novel Coronavirus Disease Pandemic

Background: Nursing staff exposed to 2019 novel coronavirus disease which might be at the increased risk of development mental health problems such as stress, anxiety and insomnia. Objectives: To estimate the spread of stress, anxiety and insomnia among the nursing staff who are working at Asir central hospital, Kingdom of Saudi Arabia. Methods: This study was a descriptive cross-sectional study, that involved with a 53 (44 Female and 9 Male) nurses who are working at Asir central hospital, Kingdom of Saudi Arabia. A convenient sampling technique was used to select the participants during the period from October to the mid of November 2020. A structured closed-ended questionnaire was used related with three standard tools (The Perceived Stress Scale, Generalized Anxiety Disorder and the Insomnia severity index). Results: The results revealed that 90.6% of participants had moderate stress and 7.5% showed low stress. Regarding anxiety, 37% of nurses had mild anxiety, 28.3% and 34% had moderate and severe anxiety, respectively. Moreover, sub-threshold insomnia was observed in 60.4% and clinical insomnia in 15% of study candidates. Additionally, a statistically significant association was found between levels of stress, anxiety and insomnia and the age of the studied nurses (P = 0.00). Conclusion: The results of this study showed that the spread of stress, anxiety and insomnia, was higher than some studies which have been reported in the previous researches. Significant difference was observed between mental distress and age of nurses, while there was no significant difference between the studied mental health problems and gender.