381 Evening Chronotype Predicts Subjective Sleep Symptom Severity in Pregnant Women with Insomnia Disorder

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A151-A151
Author(s):  
Joshua Tutek ◽  
Natalie Solomon ◽  
Jessica Dietch ◽  
Norah Simpson ◽  
Rachel Manber
Keyword(s):  
Pregnant Women ◽  
Behavioral Therapy ◽  
Stress Test ◽  
Severity Index ◽  
Future Research ◽  
Composite Scale ◽  
Insomnia Disorder ◽  
Early Postpartum ◽  
Gestational Week ◽  
Insomnia Severity

Abstract Introduction Evening chronotype is associated with greater reports of insufficient sleep and sleep-related distress. Little research has examined this relationship within the context of pregnancy. This study investigated whether eveningness predicts insomnia severity, sleep effort, dysfunctional sleep beliefs, and sleep reactivity to stress in pregnant women with insomnia disorder. Methods Pregnant women with insomnia disorder who spoke English or Spanish enrolled in a clinical trial of cognitive behavioral therapy for insomnia (N = 178; M age = 32.6 years). Before beginning treatment, participants completed the Composite Scale of Morningness (CSM), Insomnia Severity Index (ISI), Glasgow Sleep Effort Scale (GSS), Dysfunctional Beliefs and Attitudes about Stress Scale (DBAS), and Ford Insomnia Response to Stress Test (FIRST). Participants were categorized into evening, intermediate, or morning chronotypes (bottom 25%, middle 50%, or top 25% of CSM scores, respectively). MANCOVA examined whether chronotype predicted higher baseline ISI, GSS, DBAS, and FIRST scores after adjusting for age, gestational week of pregnancy, and language. Results Sleep measures collectively differed by chronotype, F(8, 336) = 4.05, p < .001; Wilk’s Λ = .83, partial η-sqd = .09. Follow-up ANOVAs testing individual dependent variables were all significant (partial η-sqd = .04 – .10, p < .05). Pairwise comparisons (Bonferroni-adjusted; p < .05) found that evening types had higher ISI scores than intermediate (M difference = 2.21) and morning types (M difference = 2.30), and higher DBAS scores than morning types (M difference = .95). Morning types had lower FIRST scores than evening (M difference = 5.44) and intermediate types (M difference = 3.89). Conclusion Evening chronotype was associated with greater insomnia severity and maladaptive sleep-related cognition than other chronotypes among pregnant women with insomnia disorder. Future research may examine whether differences in chronotype have implications for insomnia treatment outcome during pregnancy, and whether greater morningness confers protection against sleep challenges during the early postpartum period. Support (if any) NIH R01 NR013662

scholarly journals 0546 Sleep Science at Home - Delivering Sleep Assessment and Digital CBT-i at Scale

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A209-A209
Author(s):  
P J Arnal ◽  
V Thorey ◽  
E Debellemaniere ◽  
E Mordret ◽  
A Llamosi ◽  
...  
Keyword(s):  
Behavioral Therapy ◽  
Severity Index ◽  
Inclusion Criteria ◽  
Open Label ◽  
Insomnia Disorder ◽  
Sleep Assessment ◽  
Clinically Significant ◽  
New Generation ◽  
High Engagement ◽  
Insomnia Severity

Abstract Introduction Cognitive-behavioral therapy for insomnia (CBT-I) is the current first-line treatment for insomnia disorder, recommended by the AASM and SRS. Digital versions of CBT-I have been developed and validated to address the need for implementation at scale but still suffer from poor accessibility and compliance. Therefore, the aim of this open-label, Real-World Study (RWS) was to assess the engagement and efficacy of a next-generation CBT-i 6-weeks program. Methods 1304 subjects were included in the analysis between Dec 23rd, 2018 and December, 14th 2019. The main inclusion criteria were having an Insomnia Severity Index ISI ≥ 15 and completion of one week of Dreem program. The variables have been measured by the Dreem headband (DH) for objective variables, and on subjects’ answers to questionnaires for subjective ones. Results The retention during this RWS was 70.4 % (Pre: n = 1304 and Week 4: n = 935). The program led to a clinically significant decrease of 7.42 points on the ISI (p < 0.001). The obj-WASO was reduced by 35% (n = 359, p < 0.001), obj-Awakenings were reduced by 37% (n = 359 p < 0.001), obj-SE was increased by 2.56 points (n = 305, p < 0.001) and obj-SOL was reduced by 22% (n = 359, p < 0.001). The subj-SOL was reduced by 41% (n = 176, p < 0.001), subj-SE was increased by 8.9 points (n =168, p < 0.001), subj-SD was increased by 16% (baseline: 307.50 ± 88.86 min; post 357.07 ± 91.24 min, subj-SD (n = 174, p < 0.001). Conclusion The results of this RWS suggest this insomnia program has a high engagement compared to other digital CBT-I programs and is as effective as traditional in-person CBT-I. This new generation of Insomnia therapy combining hardware, software and therapist serves as an efficient and engaging treatment implementable at scale. Support This study has been supported by Dreem sas.

scholarly journals Prevalence rates and correlates of insomnia disorder in post-9/11 veterans enrolling in VA healthcare

SLEEP ◽  
2020 ◽  
Vol 43 (12) ◽  
Author(s):  
Peter J Colvonen ◽  
Erin Almklov ◽  
Jessica C Tripp ◽  
Christi S Ulmer ◽  
James O E Pittman ◽  
...  
Keyword(s):  
Stress Disorder ◽  
Severity Index ◽  
Cutoff Score ◽  
Sample Population ◽  
Prevalence Rates ◽  
Insomnia Disorder ◽  
Clinical Disorders ◽  
Nationally Representative ◽  
The Military ◽  
Insomnia Severity

Abstract Study Objectives Post-9/11 veterans are particularly vulnerable to insomnia disorder. Having accurate prevalence rates of insomnia disorder in this relatively young, diverse population, is vital to determine the resources needed to identify and treat insomnia disorder. However, there are no accurate prevalence rates for insomnia disorder in post-9/11 veterans enrolling in the VA Healthcare System (VHA). We present accurate prevalence of insomnia disorder, and correlates, in a large sample of post-9/11 veterans enrolling in a VHA. Methods This was an observational study of 5,552 post-9/11 veterans newly enrolling for health care in a VHA. Data were collected using VA eScreening. Insomnia diagnosis was determined using a clinical cutoff score of ≥ 11 on the Insomnia Severity Index. Measures also included sociodemographic, service history, posttraumatic stress disorder (PTSD), depression, suicidal ideation, alcohol misuse, military sexual trauma, traumatic brain injury (TBI), and pain intensity. Results About 57.2% of the sample population had insomnia disorder. Our sample was nationally representative for age, sex, ethnicity, branch of the military, and race. The sample also was at high-risk for a host of clinical disorders, including PTSD, TBI, and pain; all of which showed higher rates of insomnia disorder (93.3%, 77.7%, and 69.6%, respectively). Conclusions The findings suggest alarmingly high rates of insomnia disorder in this population. Examining and treating insomnia disorder, especially in the context of co-occurring disorders (e.g. PTSD), will be a necessity in the future.

scholarly journals The Effectiveness of integrating spirituality into prenatal care on Improving Sleep Quality and Insomnia Severity among Pregnant Women: A Randomized Control Trial

2021 ◽  
Author(s):  
azam maleki ◽  
Nahid Moradi ◽  
Saeedeh Zenoozian
Keyword(s):  
Prenatal Care ◽  
Sleep Quality ◽  
Pregnant Women ◽  
Controlled Trial ◽  
Intervention Group ◽  
Severity Index ◽  
First Trimester ◽  
Routine Care ◽  
Control Group ◽  
Insomnia Severity

Abstract Background To determine the effectiveness of integrating spirituality into prenatal care on Improving Sleep Quality and Insomnia Severity among Pregnant Women. Methods This randomized controlled trial was carried out on 40 pregnant women recruited at five health centers of zanjan, Iran, 2020. The eligible women were allocated into two intervention and control groups according to the randomized design. Group counselling with spiritual content was carried out in eight sessions, two times a week at 16 to 20 weeks of gestation. The control group only received routine care. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) questionnaires in three stages, before the intervention, at 28 and 36 weeks of gestation. Statistical analysis was performed using the SPSS 16.0 software (SPSS Inc., Chicago, IL, USA). Results The results showed that comparing the mean score of insomnia severity, sleep quality and its components in the pre-intervention phase was not statistically significant between the two groups(p>0.05). Comparison of the insomnia severity, sleep quality, and its components scores decreased statistically in the second and third trimesters compared to the first trimester in the intervention group than the control group(p<0.05). The effect of the intervention (Eta score) was 64%. Conclusion The results showed that counselling with spiritual content could effectively ameliorate sleep quality and reduce insomnia severity in pregnant women. It seems that the approach is an acceptable basis to design intervention programs in this field that can be considered by midwives.

scholarly journals Efficacy of Online Versus In-Person Cognitive Behavioral Therapy for Insomnia

2020 ◽  
Vol 3 ◽  
Author(s):  
Emily Wilson ◽  
Aaron Roberts
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Severity Index ◽  
The United States ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Insomnia Severity ◽  
Over Time

Background and Hypothesis: Up to 30% of the adult population may suffer from insomnia symptoms. Insomnia not only diminishes the individual’s quality of life, but also has a broad financial impact, costing the United States over $100 billion per year. Systemic barriers limit access to cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia. However, newly developed internet CBT-I (iCBT-I) programs, if effective, may reduce this disparity. In this study, we hypothesized that there is no difference in the efficacy of the experimental iCBT-I and the control CBT-I interventions in reducing insomnia severity over time.    Project Methods: A projected 120 participants will be recruited for this non-inferiority prospective cohort study. 60 patients will be assigned to each arm of the study (CBT-I and iCBT-I). The control group will attend 6 in-person CBT-I sessions over 6 weeks. The experimental group will complete the iCBT-I program Go! To Sleep over 6 weeks. Participants will complete the Insomnia Severity Index (ISI) before and after treatment, as well as 3, 6, and 12 months after finishing the program. The Kruskal-Wallis statistical test will utilize ISI data to compare efficacy of the interventions over time.     Results: Based on previous literature, the projected results of this study align with the hypothesis that there will be no difference in efficacy of the CBT-I and iCBT-I interventions over time.    Potential Impact: If indeed there is no difference in effectiveness between the iCBT-I program and in-person CBT-I, this result would have implications in clinical decision-making. Improved access to iCBT-I may reduce prescriptions for addictive pharmacologic treatments, as well as offer an inexpensive, convenient, and effective treatment for insomnia. Future studies could compare efficacy of iCBT-I in patients with co-morbidities, such as anxiety or depression.  

Psychometric Properties of Two Brief Versions of Cognitive, Insomnia-Specific Measures: The Anxiety and Preoccupation About Sleep Questionnaire and the Sleep-Associated Monitoring Index

2019 ◽  
Vol 123 (3) ◽  
pp. 966-982
Author(s):  
Markus Jansson-Fröjmark ◽  
Rikard Sunnhed
Keyword(s):  
Psychometric Properties ◽  
Severity Index ◽  
Process Measures ◽  
Student Sample ◽  
Sleep Questionnaire ◽  
Insomnia Disorder ◽  
Two Samples ◽  
Two Measures ◽  
Monitoring Index ◽  
Insomnia Severity

Aim The purpose of this study was to examine the psychometric properties of two brief versions of previously validated cognitive process measures in insomnia: the Anxiety and Preoccupation about Sleep Questionnaire and the Sleep-Associated Monitoring Index. Methods Two samples (168 students and 219 patients with insomnia disorder) completed original and brief versions of the two measures (Anxiety and Preoccupation about Sleep Questionnaire-Brief version and Sleep-Associated Monitoring Index-Brief version). Also, they filled out sociodemographic questions, sleep items, and the Insomnia Severity Index. Results In both samples, the internal consistencies of the two brief versions were acceptable at α = .70 to.72. The correlations between the original and brief versions were significant at .79 to .82. The two brief versions were also significantly associated with insomnia severity and nighttime symptomatology. In the student sample, those with likely insomnia disorder (14.9% of the sample) scored significantly higher on the two brief versions, relative to those without insomnia. Conclusion The two brief versions, Anxiety and Preoccupation about Sleep Questionnaire-Brief version and Sleep-Associated Monitoring Index-Brief version, displayed acceptable psychometric properties. This implies that the two brief versions might be viable alternatives for use in clinical and research settings.

scholarly journals Influence of a Concurrent Exercise Training Intervention during Pregnancy on Maternal and Arterial and Venous Cord Serum Cytokines: The GESTAFIT Project

2019 ◽  
Vol 8 (11) ◽  
pp. 1862 ◽  
Author(s):  
Acosta-Manzano ◽  
Coll-Risco ◽  
Van Poppel ◽  
Segura-Jiménez ◽  
Femia ◽  
...  
Keyword(s):  
Exercise Training ◽  
Pregnant Women ◽  
Exercise Group ◽  
Future Research ◽  
Exercise Interventions ◽  
Cord Serum ◽  
Serum Cytokines ◽  
Tnf Α ◽  
Gestational Week ◽  
Concurrent Exercise

The aim of the present study was to analyze the influence of a supervised concurrent exercise-training program, from the 17th gestational week until delivery, on cytokines in maternal (at 17th and 35th gestational week, and at delivery) and arterial and venous cord serum. Fifty-eight Caucasian pregnant women (age: 33.5 ± 4.7 years old, body mass index: 23.6 ± 4.1kg/m2) from the GESTAFIT Project (exercise (n = 37) and control (n = 21) groups) participated in this quasi-experimental study (per-protocol basis). The exercise group followed a 60-min 3 days/week concurrent (aerobic-resistance) exercise-training from the 17th gestational week to delivery. Maternal and arterial and venous cord serum cytokines (fractalkine, interleukin (IL)–1β, IL-6, IL-8, IL-10, interferon (IFN)–γ, and tumor necrosis factor (TNF)–α) were assessed using Luminex xMAP technology. In maternal serum (after adjusting for the baseline values of cytokines), the exercise group decreased TNF-α (from baseline to 35th week, p = 0.02), and increased less IL-1β (from baseline to delivery, p = 0.03) concentrations than controls. When adjusting for other potential confounders, these differences became non-significant. In cord blood, the exercise group showed reduced arterial IL-6 and venous TNF-α (p = 0.03 and p = 0.001, respectively) and higher concentrations of arterial IL-1β (p = 0.03) compared to controls. The application of concurrent exercise-training programs could be a strategy to modulate immune responses in pregnant women and their fetuses. However, future research is needed to better understand the origin and clearance of these cytokines, their role in the maternal-placental-fetus crosstalk, and the influence of exercise interventions on them.

scholarly journals 1108 Associations Between Insomnia And Anxiety Symptoms: Which Elements Of Insomnia Are Associated With Which Elements Of Anxiety?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A421-A422
Author(s):  
A Kapoor ◽  
M L Perlis ◽  
C Bastien ◽  
N Williams ◽  
L Hale ◽  
...  
Keyword(s):  
Severity Index ◽  
Anxiety Symptoms ◽  
Anxiety Level ◽  
Future Research ◽  
Loss Of Control ◽  
Regression Analyses ◽  
Race Ethnicity ◽  
Healthy Activity ◽  
Insomnia Severity ◽  
Anxiety Questionnaire

Abstract Introduction It is still not clear which aspects of insomnia are associated with various aspects of anxiety problems. Knowing this could better guide treatment of insomnia comorbid with anxiety. Methods Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study were used, including N=1003 adults age 22-60. All participants completed the Insomnia Severity Index (ISI) and the GAD7 anxiety questionnaire. The ISI was divided into 3 sections, based on prior work: SLEEP symptoms (difficulty sleeping), DAYTIME symptoms (difficulty functioning), and PERCEPTION symptoms (dissatisfaction). GAD7 items included anxiety level, loss of control, worry about many things, difficulty relaxing, restlessness, irritability, and fear. Logistic regression analyses examined each symptom, with each component of the ISI as predictor, as well as age, sex, race/ethnicity and education as covariates. Results SLEEP symptoms were independently associated with control (OR=1.09, p=0.03), many worries (OR=1.1, p=0.017), restlessness (OR=1.1, p=0.009), and irritability (OR=1.1, p=0.04). DAYTIME symptoms were independently associated with anxiety level (OR=1.3, p&lt;0.0005), control (OR=1.2, p&lt;0.0005), many worries (OR=1.3, p&lt;0.0005), difficulty relaxing (OR=1.2, p=0.004), restlessness (OR=1.3, p=0.001), and irritability (OR=1.2, p&lt;0.0005). PERCEPTION symptoms were uniquely, independently associated with anxiety level (OR=1.1, p=0.03), control (OR=1.2, p=0.001), many worries (OR=1.2, p=0.001), difficulty relaxing (OR=1.4, p&lt;0.0005), irritability (OR=1.2, p=0.018), and feelings of fear (OR=1.2, p=0.002). Conclusion The DAYTIME and PERCEPTION symptoms of insomnia were strongly related to anxiety symptoms. Current treatments for insomnia focus mainly on improving sleep. Future research should test the hypothesis that treating daytime symptoms of insomnia may aid patients with comorbid anxiety. Support The SHADES study was funded by R21ES022931. Dr. Grandner is supported by R01MD011600.

Acupuncture for Sleep Disturbances in Post-Deployment Military Service Members: A Randomized Controlled Trial

2021 ◽  
pp. 105477382110306
Author(s):  
Jane J. Abanes ◽  
Sheila H. Ridner ◽  
Mary S. Dietrich ◽  
Cynthia Hiers ◽  
Bethany Rhoten
Keyword(s):  
Military Service ◽  
Sleep Disturbances ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Severity Index ◽  
Reliable Change Index ◽  
Military Service Members ◽  
The Difference ◽  
Journal Entries ◽  
Insomnia Severity

This RCT and mixed-methods study examined the difference between two groups receiving the following interventions: (1) brief manual standardized stress acupuncture (MSSA) combined with an abbreviated Cognitive Behavioral Therapy (ACBT) versus (2) ACBT alone. Three study aims: Aim (1): Insomnia Severity Index (ISI) and Pittsburg Sleep Quality Index (PSQI) scores were analyzed using descriptive summaries, linear regression, and reliable change index (RCI). Aim (2): Journal entries were analyzed using content analysis. Aim (3): Acupuncture Expectancy Scale (AES) scores were analyzed using paired t-test and RCI. Aim (1): Both groups demonstrated similar improvements in the ISI scores ( p = .480). Aim (2): The ACBT/MSSA group reported greater benefits in sleep and in other life areas including mental, physical, and social functioning. Aim (3): The AES showed that 21.6% had a clinically meaningful increase in expectations in the effect of acupuncture for stress ( p = .965). The study was registered in ClinicalTrials.gov (NCT04031365) at https://clinicaltrials.gov/ct2/show/NCT04031365 on July 24, 2019.

scholarly journals P096 Subjective ratings of medication strength of lemborexant over 6 months in subjects with moderate or severe insomnia

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A52-A52
Author(s):  
C Drake ◽  
J Yardley ◽  
K Pinner ◽  
M Moline
Keyword(s):  
Severity Index ◽  
Subjective Ratings ◽  
Phase 3 ◽  
Double Blind ◽  
Patient Global Impression ◽  
Insomnia Disorder ◽  
Patient Reported ◽  
Positive Effect ◽  
Insomnia Severity

Abstract Introduction In Study 303 (SUNRISE-2), significantly more subjects reported a positive effect of lemborexant (LEM), a dual orexin receptor antagonist, versus placebo (PBO) on their sleep at 1mo, 3mo and 6mo, as assessed by items 1–3 of the Patient Global Impression–Insomnia (PGI-I). LEM-treated subjects also reported larger and statistically significant decreases in the Insomnia Severity Index (ISI) versus PBO. This analysis examined potential LEM tolerance via patient-reported ratings of medication strength on PGI-I item 4 in subjects with moderate/severe insomnia. Methods In this 12mo double-blind, PBO-controlled (first 6mo), phase 3 study, subjects ≥18y with insomnia disorder and ISI scores ≥15 were randomized to PBO (n=318) or LEM (5mg, [LEM5], n=316; 10mg, [LEM10], n=315). The ISI and PGI-I were administered at 1mo, 3mo and 6mo. Results The percentage of subjects with moderate (ISI=15–21; n=692) or severe (ISI=22–28; n=223) insomnia at baseline who rated LEM as “just right” increased from 1mo (moderate: LEM5=46.4%; LEM10=43.3%; PBO=31.3%; severe: LEM5=35.8%; LEM10=40.6%; PBO=15.0%) to 6mo (moderate: LEM5=56.5%; LEM10=53.9%; PBO=39.7%; severe: LEM5= 54.8%; LEM10=55.4%; PBO=21.6%). Ratings of “too weak” decreased over 6 months in both ISI severity groups. PBO group ratings of “too weak” always exceeded the LEM groups by &gt;15%. Ratings of “too strong” were low and stable over time. Conclusions Findings suggest that LEM tolerance does not occur over 6mo with either LEM dose since patient perceptions of LEM treatment being “too weak” did not increase over the study period. These data support the persistent efficacy of long-term LEM treatment for chronic insomnia.

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