Treating Insomnia during the COVID-19 Pandemic: Observations and Perspectives from a Behavioral Sleep Medicine Clinic

Abstract Introduction Due to the COVID-19 pandemic, many individuals are likely experiencing increased stress and social isolation. This study aimed to examine the effect of perceived stress and social isolation on self-reported continuous positive airway pressure (CPAP) use and treatment adherence among sleep medicine clinic patients during the pandemic. Methods Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9y, 44% male, 69% Caucasian) completed an online survey that included self-reported changes in CPAP use and using CPAP as advised; and PROMIS Social Isolation and Perceived Stress Scale (PSS). CPAP measures were categorized based on reported changes during the pandemic. Stepwise logistic regression was performed using SAS to determine if Social Isolation and PSS predicted change in CPAP measures. Results Among participants, 53% reported using CPAP. Out of those, 61% reported change, 16% reported no change, and 23% reported they do not know if there is a change in using CPAP as advised during the pandemic. Social Isolation predicted an increase in odds of CPAP use by a factor of 1.15 (p=0.024). PSS predicted a decrease in odds of using CPAP therapy as advised by a factor of 0.86 (p=0.049). Conclusion Increases in perceived stress predicted lower odds of utilizing CPAP as advised. Increases in self-reported social isolation predicted greater odds of CPAP use in sleep medicine clinic patients during the COVID-19 pandemic. Addressing stressors/coping and social isolation/support as part of routine clinical care in sleep medicine clinic patients is advised. Support (if any) This work is supported by National Institutes of Health Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).

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A RETROSPECTIVE ANALYSIS ON THE DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH EXCESSIVE DAYTIME SLEEPINESS PRESENTING TO THE SLEEP MEDICINE CLINIC HOSPITAL TAIPING

Respirology ◽

10.1111/resp.13420_623 ◽

2018 ◽

Vol 23 ◽

pp. 313-313

Keyword(s):

Retrospective Analysis ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Sleep Medicine ◽

Demographic Characteristics ◽

Medicine Clinic ◽

Clinic Hospital

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707 Association of Self-Reported Anxiety, Informational Support, and Sleep in Sleep Medicine Patients during the COVID-19 Pandemic

SLEEP ◽

10.1093/sleep/zsab072.705 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A276-A276

Author(s):

Emily Arentson-Lantz ◽

Ahmad Debian ◽

Manasa Kokanda ◽

Fidaa Shaib ◽

Sara Nowakowski

Keyword(s):

Sleep Disturbance ◽

Sleep Medicine ◽

Sunlight Exposure ◽

Stressful Events ◽

Accurate Information ◽

Health Administration ◽

Informational Support ◽

Caffeine Consumption ◽

Medicine Clinic ◽

Insomnia Severity

Abstract Introduction Stressful events, such as the COVID-19 pandemic, can have a detrimental effect on sleep. It is important for practitioners to understand how their patients are affected by events to optimize their care. In this study we evaluated associations of anxiety and daily habits with self-reported sleep disturbance among sleep medicine clinic patients. Methods Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9 y, 44% male, 69% Caucasian) completed an online survey that included PROMIS measures (Sleep Disturbance, Sleep-Related Impairments, Informational Support, Emotional Distress-Anxiety) and Insomnia Severity Index (ISI). Patients were asked about changes in their daily habits (sunlight exposure, caffeine consumption). During the 5-month survey completion time window, the weekly average of positive COVID-19 cases in the Houston area was 2,914. Stepwise linear regression was performed using SAS to determine if self-reported anxiety and informational support predicted PROMIS Sleep Disturbance, PROMIS Sleep-Related Impairments and ISI. Results Anxiety had a significant effect on Sleep Disturbance (0.43 ± 0.11, p=0.0001), Sleep-Related Impairments (0.53 ± 0.12, p=0.0001) and ISI (0.28 ± 0.08, p=0.0004). Informational support had a significant inverse effect on Sleep Disturbance (-0.29 ± 0.10, p=0.0063), Sleep-Related Impairments (-0.26 ± 0.11, p=0.01) and ISI (-0.31 ± 0.08, p<0.0001) measures. Decreased sunlight exposure during the pandemic contributed to a significant increase in Sleep Disturbance scores (0.06 ± 0.03, p=0.045). Increased caffeine consumption during the pandemic had significant increase in ISI scores (16.3 ± 7.59, p=0.035). Conclusion Higher levels of anxiety and lower levels of informational support predicted greater insomnia severity, sleep disturbance, and sleep-related impairments in sleep medicine clinic patients during the COVID-19 pandemic. Decreased sunlight exposure and increased caffeine consumption also predicted greater sleep disturbance and insomnia severity, respectively. Addressing anxiety symptoms and access to accurate information during the pandemic is advised when treating sleep medicine clinic patients. Support (if any) This work is supported by National Institutes of Health (NIH) Grant # R01NR018342 (PI: Nowakowski) and by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).

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718 Investigating Decreased Positive Airway Pressure Compliance in a Veteran Affairs Sleep Medicine Clinic During the 2020 Pandemic

SLEEP ◽

10.1093/sleep/zsab072.716 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A280-A280

Author(s):

David Earl ◽

Nicholas Cutrufello ◽

Joseph Kern ◽

Melissa Begay ◽

Madeleine Grigg-Damberger ◽

...

Keyword(s):

Airway Pressure ◽

Primary Outcome ◽

Positive Airway Pressure ◽

Sleep Medicine ◽

Medicine Clinic ◽

Time Period ◽

Barriers And Challenges ◽

Barriers To Use ◽

Set Up ◽

Machine Replacement

Abstract Introduction Positive airway pressure (PAP) compliance for the treatment of sleep apnea at the Albuquerque Veterans Affairs (VA) Sleep Medicine clinic has been observed to be lower in new setup patients after the onset of the COVID-19 pandemic. The reasons for decreased PAP compliance during the COVID-19 pandemic are unclear. The primary outcome will be to identify if there is a common reason that patients at the Albuquerque VA were less compliant with PAP after the onset of the COVID-19 pandemic. Methods Compliance data for 4/1/2020 through 9/30/2020 was compared to compliance data for 4/1/2019 through 9/30/2019. Compliance after PAP machine setup was confirmed to be lower during the 2020 time period. Noncompliant patients will be selected by setup type, new versus machine replacement, and surveyed for reasons for noncompliance. The survey will be conducted at the Albuquerque VA Sleep Center and will include questions regarding beliefs, barriers, and challenges with the use of PAP therapy during the coronavirus pandemic. The definition for initial PAP compliance will be the use of PAP therapy for greater than or equal to four hours per night on at least 70% of nights. Results For the 6-month time period of 4/1/2019 through 9/30/2019, there were 758 PAP setups at the Albuquerque VA. The 30-day compliance for the 758 setups was found to be 61.4%. Comparatively, for the six-month period of 4/1/2020 through 9/30/2020, there were 462 setups with a 30-day compliance result of 49.7%. A survey consisting of questions designed to elicit barriers to use as well as beliefs regarding PAP and COVID-19 will be administered to 20% (n = 46) of the non-compliant patients who were set up with a PAP machine during the 2020 study period. Conclusion PAP compliance after machine setup was lower at the Albuquerque VA sleep center in 2020 versus 2019 (49.7% versus 61.4%). The reasons for the lower observed compliance are attributed to the effects of the coronavirus pandemic. A random sampling of the non-compliant patients during the 2020 time period will be performed and the results will be presented once available. Support (if any) None

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1254 Sleep Related Hallucinations As Presenting Symptom Of Dementia With Lewy Bodies: A Case Report

SLEEP ◽

10.1093/sleep/zsaa056.1248 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A477-A478

Author(s):

Arun Nag Santhosh Mallapareddi ◽

Brooke Judd

Keyword(s):

Female Patient ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Sleep Medicine ◽

Medicine Clinic ◽

Obstructive Sleep ◽

Falling Asleep ◽

Patient Reported ◽

History Of ◽

Severe Degree

Abstract Introduction Visual hallucinations are one of the prominent symptoms of Dementia with Lewy Bodies (DLB). These hallucinations are often vivid and bothersome to patients. There is limited literature regarding patients with DLB presenting with hypnopompic/hypnagogic hallucinations as the initial chief complaint. We report a case of a 77 year old female patient presenting to sleep medicine clinic with history of newer onset sleep-related hallucinations as well as concerns for sleep-disordered breathing, but was subsequently diagnosed with DLB. Report of Case 77 year old female patient initially presented to PCP with a one year history of disturbing hallucinations while falling asleep. Additionally, patient had excessive daytime sleepiness along with family history significant for obstructive sleep apnea (OSA). Given the concerns of parasomnias and OSA, patient was referred to Sleep Medicine clinic. On presentation, patient continued to have hypnogogic/hypnopompic hallucinations along with symptoms concerning for OSA. An in-lab polysomnogram (PSG) was performed, which demonstrated evidence of a moderate to severe degree of OSA. Patient reported hypnopompic hallucination on the night of PSG. CPAP therapy was initiated. Despite treatment, her sleep-related hallucinations continued. She also began to have daytime hallucinations as well as cognitive impairment. Due to progression of symptoms despite treatment of OSA, neurology consultation was recommended. Per neurology evaluation, patient received PET CT metabolites which demonstrated changes consistent with DLB. Conclusion DLB should be considered as one of the differential diagnosis in patients presenting with hypnagogic/hypnopompic hallucinations especially if the patient has other signs of dementia.

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