Pub Date : 2024-01-10DOI: 10.3389/frsle.2023.1328558
Lauren Dobson, Ella Milne, Heather Halperin, Deborah Olmstead, Shannon D. Scott, M. Castro-Codesal
The COVID-19 pandemic has resulted in drastic changes in people's lives, more so in individuals with chronic conditions, such as children with chronic respiratory disorders requiring home non-invasive ventilation. Our research question was: How has the COVID-19 pandemic affected the daily lives of children using home NIV and their families and their NIV adherence?An anonymous online survey was administered to caregivers of pediatric patients using home NIV followed at the Stollery's Pediatric NIV Program in Alberta, Canada, between September 2020 and September 2021. Thematic analysis was conducted for the identification of emerging themes.Four themes were identified: (1) positive effects, (2) negative effects, (3) neutral effects, and (4) impact on NIV adherence. Effects of COVID-19 on children and families were reported by 55 respondents (57% response rate). Positive effects included a slower lifestyle, more family time, and less recurrent acute respiratory illness. Negative effects included increased parental anxiety, prolonged social isolation beyond imposed restrictions, and limited access to health supplies. Despite these negative effects, 90% of respondents reported adequate maintenance or even increases in their child's NIV use. A general sense of benefit in the virtual specialized care model was also highlighted.COVID-19 resulted in varying levels of impact on the lives of children using NIV, not unlike the general population. Negative effects, however, appeared to intensify in these technology-dependent children. NIV adherence, however, was prioritized by families and even increased during COVID-19. Further research is needed to analyse the potential benefits of virtual models of specialized care.
{"title":"Impact of COVID-19 pandemic in children using non-invasive ventilation: a thematic analysis of caregivers answers to a survey study","authors":"Lauren Dobson, Ella Milne, Heather Halperin, Deborah Olmstead, Shannon D. Scott, M. Castro-Codesal","doi":"10.3389/frsle.2023.1328558","DOIUrl":"https://doi.org/10.3389/frsle.2023.1328558","url":null,"abstract":"The COVID-19 pandemic has resulted in drastic changes in people's lives, more so in individuals with chronic conditions, such as children with chronic respiratory disorders requiring home non-invasive ventilation. Our research question was: How has the COVID-19 pandemic affected the daily lives of children using home NIV and their families and their NIV adherence?An anonymous online survey was administered to caregivers of pediatric patients using home NIV followed at the Stollery's Pediatric NIV Program in Alberta, Canada, between September 2020 and September 2021. Thematic analysis was conducted for the identification of emerging themes.Four themes were identified: (1) positive effects, (2) negative effects, (3) neutral effects, and (4) impact on NIV adherence. Effects of COVID-19 on children and families were reported by 55 respondents (57% response rate). Positive effects included a slower lifestyle, more family time, and less recurrent acute respiratory illness. Negative effects included increased parental anxiety, prolonged social isolation beyond imposed restrictions, and limited access to health supplies. Despite these negative effects, 90% of respondents reported adequate maintenance or even increases in their child's NIV use. A general sense of benefit in the virtual specialized care model was also highlighted.COVID-19 resulted in varying levels of impact on the lives of children using NIV, not unlike the general population. Negative effects, however, appeared to intensify in these technology-dependent children. NIV adherence, however, was prioritized by families and even increased during COVID-19. Further research is needed to analyse the potential benefits of virtual models of specialized care.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-05DOI: 10.3389/frsle.2023.1294957
M. Wunderlin, C. Zeller, Korian Wicki, Christoph Nissen, M. Züst
In young healthy adults, phase-locked acoustic stimulation (PLAS) during slow wave sleep (SWS) can boost over-night episodic memory consolidation. In older adults, evidence is scarce and available results are inconsistent, pointing toward reduced PLAS-effectiveness. We argue that multiple stimulation nights are required for effects to unfold in older individuals to compensate for age-related reductions in both SWS and memory performance. We test this assumption in a longitudinal within-subject design.In a larger previous project, older adults participated in a three-night intervention receiving either real-PLAS (STIM group) or sham-PLAS (SHAM group). Encoding and immediate recall of face-occupation pairs was administered on the evening of the first intervention night (session one), with feedback-based retrievals ensuing on all following mornings and evenings across the intervention. To test for the benefit of the real-PLAS over sham-PLAS intervention within participants, 16 older adults [agemean: 68.9 (SD: 3.7)] were re-invited receiving the real-PLAS intervention exclusively. This resulted in a SHAMSTIM group (n = 9; T1: sham-PLAS intervention, T2: real-PLAS intervention) and a STIMSTIM group (n = 7; T1 and T2: real-PLAS intervention).While the STIMSTIM group exhibited highly similar responses during T1 and T2, the SHAMSTIM group exhibited a significantly higher increase in memory performance at T2 (real-PLAS) compared to T1 (sham-PLAS). These gains can be attributed to the late stages of the experiment, after three nights of real-PLAS, and remained stable when correcting for changes in baseline sleep quality (PSQI) and baseline cognitive ability (Montreal Cognitive Assessment) between T1 and T2.We show that in older adults, PLAS-induced memory effects are delayed and manifest over the course of a three-night-PLAS intervention. Our results might explain the lack of effects in previous PLAS studies, where memory performance was solely assessed after a single night of PLAS.
{"title":"Acoustic stimulation during slow wave sleep shows delayed effects on memory performance in older adults","authors":"M. Wunderlin, C. Zeller, Korian Wicki, Christoph Nissen, M. Züst","doi":"10.3389/frsle.2023.1294957","DOIUrl":"https://doi.org/10.3389/frsle.2023.1294957","url":null,"abstract":"In young healthy adults, phase-locked acoustic stimulation (PLAS) during slow wave sleep (SWS) can boost over-night episodic memory consolidation. In older adults, evidence is scarce and available results are inconsistent, pointing toward reduced PLAS-effectiveness. We argue that multiple stimulation nights are required for effects to unfold in older individuals to compensate for age-related reductions in both SWS and memory performance. We test this assumption in a longitudinal within-subject design.In a larger previous project, older adults participated in a three-night intervention receiving either real-PLAS (STIM group) or sham-PLAS (SHAM group). Encoding and immediate recall of face-occupation pairs was administered on the evening of the first intervention night (session one), with feedback-based retrievals ensuing on all following mornings and evenings across the intervention. To test for the benefit of the real-PLAS over sham-PLAS intervention within participants, 16 older adults [agemean: 68.9 (SD: 3.7)] were re-invited receiving the real-PLAS intervention exclusively. This resulted in a SHAMSTIM group (n = 9; T1: sham-PLAS intervention, T2: real-PLAS intervention) and a STIMSTIM group (n = 7; T1 and T2: real-PLAS intervention).While the STIMSTIM group exhibited highly similar responses during T1 and T2, the SHAMSTIM group exhibited a significantly higher increase in memory performance at T2 (real-PLAS) compared to T1 (sham-PLAS). These gains can be attributed to the late stages of the experiment, after three nights of real-PLAS, and remained stable when correcting for changes in baseline sleep quality (PSQI) and baseline cognitive ability (Montreal Cognitive Assessment) between T1 and T2.We show that in older adults, PLAS-induced memory effects are delayed and manifest over the course of a three-night-PLAS intervention. Our results might explain the lack of effects in previous PLAS studies, where memory performance was solely assessed after a single night of PLAS.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139382481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-04DOI: 10.3389/frsle.2023.1304647
Allison Monterastelli, John Adams, C. Eastman, S. Crowley
The propensity for sleep shifts later as puberty progresses. The present analysis examines whether the circadian-dependent wake maintenance zone, or forbidden zone for sleep observed in the evening just before habitual bedtime is more pronounced in late to post-pubertal adolescents compared to adults and may partly explain late sleep onset in maturing adolescents.Forty four healthy late/post-pubertal adolescents (aged 14.3–17.8 years, 23 female) and 44 healthy adults (aged 30.8–45.8 years, 21 female) participated in an ultradian light/dark protocol for 3 days cycling between 2-h wake periods (~20 lux) and 2-h nap periods (~0 lux) without external time cues. The dim light melatonin onset (DLMO), a measure of circadian phase, was measured immediately before the ultradian protocol by sampling saliva every 30 min in dim light. Wrist actigraphs were used to assess sleep onset latency and total sleep time during the naps that occurred during the ultradian sleep/wake schedule. Sleep episodes were grouped into 2-h bins relative to individual DLMOs (28–56 naps/bin). Sleep onset and total sleep time were compared between adolescents and adults as well as between males and females within each age group.Adolescents took significantly longer to fall asleep compared to adults during naps that occurred in the 4 h window surrounding the DLMO [2h before DLMO t(50) = 2.13, p = 0.04; 2 h after DLMO t(33) = 3.25, p = 0.003]. Adolescents also slept significantly less than adults during naps that occurred in the 4-h window surrounding DLMO [2 h before DLMO t(51) = −2.91, p = 0.01; 2 h after DLMO t(33) = −1.99, p = 0.05]. Adolescent males slept less than adolescent females in naps that occurred in the 2 h window after the DLMO [t(14) = −2.24, p = 0.04].Compared to adults, late/post-pubertal adolescents showed greater difficulty falling asleep and maintaining sleep around the time of their DLMO, which usually occurs a few hours before habitual sleep onset. A greater amplitude in the circadian-driven forbidden zone for sleep could be an additional physiological mechanism explaining why maturing adolescents find it difficult to fall asleep early, increasing the risk for restricted sleep in the context of early school start times.
{"title":"The forbidden zone for sleep is more robust in adolescents compared to adults","authors":"Allison Monterastelli, John Adams, C. Eastman, S. Crowley","doi":"10.3389/frsle.2023.1304647","DOIUrl":"https://doi.org/10.3389/frsle.2023.1304647","url":null,"abstract":"The propensity for sleep shifts later as puberty progresses. The present analysis examines whether the circadian-dependent wake maintenance zone, or forbidden zone for sleep observed in the evening just before habitual bedtime is more pronounced in late to post-pubertal adolescents compared to adults and may partly explain late sleep onset in maturing adolescents.Forty four healthy late/post-pubertal adolescents (aged 14.3–17.8 years, 23 female) and 44 healthy adults (aged 30.8–45.8 years, 21 female) participated in an ultradian light/dark protocol for 3 days cycling between 2-h wake periods (~20 lux) and 2-h nap periods (~0 lux) without external time cues. The dim light melatonin onset (DLMO), a measure of circadian phase, was measured immediately before the ultradian protocol by sampling saliva every 30 min in dim light. Wrist actigraphs were used to assess sleep onset latency and total sleep time during the naps that occurred during the ultradian sleep/wake schedule. Sleep episodes were grouped into 2-h bins relative to individual DLMOs (28–56 naps/bin). Sleep onset and total sleep time were compared between adolescents and adults as well as between males and females within each age group.Adolescents took significantly longer to fall asleep compared to adults during naps that occurred in the 4 h window surrounding the DLMO [2h before DLMO t(50) = 2.13, p = 0.04; 2 h after DLMO t(33) = 3.25, p = 0.003]. Adolescents also slept significantly less than adults during naps that occurred in the 4-h window surrounding DLMO [2 h before DLMO t(51) = −2.91, p = 0.01; 2 h after DLMO t(33) = −1.99, p = 0.05]. Adolescent males slept less than adolescent females in naps that occurred in the 2 h window after the DLMO [t(14) = −2.24, p = 0.04].Compared to adults, late/post-pubertal adolescents showed greater difficulty falling asleep and maintaining sleep around the time of their DLMO, which usually occurs a few hours before habitual sleep onset. A greater amplitude in the circadian-driven forbidden zone for sleep could be an additional physiological mechanism explaining why maturing adolescents find it difficult to fall asleep early, increasing the risk for restricted sleep in the context of early school start times.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139386173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-03DOI: 10.3389/frsle.2023.1265006
Kristine A. Wilckens, Rima F. Habte, Yue Dong, M. Stepan, Kibra M. Dessa, Alexis B. Whitehead, Christine W. Peng, Mary E. Fletcher, Daniel J. Buysse
Identifying intervention methods that target sleep characteristics involved in memory processing is a priority for the field of cognitive aging. Older adults with greater sleep efficiency and non-rapid eye movement slow-wave activity (SWA) (0.5–4 Hz electroencephalographic activity) tend to exhibit better memory and cognitive abilities. Paradoxically, long total sleep times are consistently associated with poorer cognition in older adults. Thus, maximizing sleep efficiency and SWA may be a priority relative to increasing mere total sleep time. As clinical behavioral sleep treatments do not consistently enhance SWA, and propensity for SWA increases with time spent awake, we examined with a proof-of concept pilot intervention whether a greater dose of time-in-bed (TiB) restriction (75% of habitual TiB) would increase both sleep efficiency and SWA in older adults with difficulties staying asleep without impairing memory performance.Participants were adults ages 55–80 with diary-reported sleep efficiency < 90% and wake after sleep onset (WASO) >20 min. Sleep diary, actigraphy, polysomnography (PSG), and paired associate memory acquisition and retention were assessed before and after a week-long TiB restriction intervention (n = 30). TiB was restricted to 75% of diary-reported habitual TiB. A comparison group of n = 5 participants repeated assessments while following their usual sleep schedule to obtain preliminary estimates of effect sizes associated with repeated testing.Subjective and objective sleep measures robustly improved in the TiB restriction group for sleep quality, sleep depth, sleep efficiency and WASO, at the expense of TiB and time spent in N1 and N2 sleep. As hypothesized, SWA increased robustly with TiB restriction across the 0.5–4 Hz range, as well as subjective sleep depth, subjective and objective WASO. Despite increases in sleepiness ratings, no impairments were found in memory acquisition or retention.A TiB restriction dose equivalent to 75% of habitual TiB robustly increased sleep continuity and SWA in older adults with sleep maintenance difficulties, without impairing memory performance. These findings may inform long-term behavioral SWA enhancement interventions aimed at improving memory performance and risk for cognitive impairments.
{"title":"A pilot time-in-bed restriction intervention behaviorally enhances slow-wave activity in older adults","authors":"Kristine A. Wilckens, Rima F. Habte, Yue Dong, M. Stepan, Kibra M. Dessa, Alexis B. Whitehead, Christine W. Peng, Mary E. Fletcher, Daniel J. Buysse","doi":"10.3389/frsle.2023.1265006","DOIUrl":"https://doi.org/10.3389/frsle.2023.1265006","url":null,"abstract":"Identifying intervention methods that target sleep characteristics involved in memory processing is a priority for the field of cognitive aging. Older adults with greater sleep efficiency and non-rapid eye movement slow-wave activity (SWA) (0.5–4 Hz electroencephalographic activity) tend to exhibit better memory and cognitive abilities. Paradoxically, long total sleep times are consistently associated with poorer cognition in older adults. Thus, maximizing sleep efficiency and SWA may be a priority relative to increasing mere total sleep time. As clinical behavioral sleep treatments do not consistently enhance SWA, and propensity for SWA increases with time spent awake, we examined with a proof-of concept pilot intervention whether a greater dose of time-in-bed (TiB) restriction (75% of habitual TiB) would increase both sleep efficiency and SWA in older adults with difficulties staying asleep without impairing memory performance.Participants were adults ages 55–80 with diary-reported sleep efficiency < 90% and wake after sleep onset (WASO) >20 min. Sleep diary, actigraphy, polysomnography (PSG), and paired associate memory acquisition and retention were assessed before and after a week-long TiB restriction intervention (n = 30). TiB was restricted to 75% of diary-reported habitual TiB. A comparison group of n = 5 participants repeated assessments while following their usual sleep schedule to obtain preliminary estimates of effect sizes associated with repeated testing.Subjective and objective sleep measures robustly improved in the TiB restriction group for sleep quality, sleep depth, sleep efficiency and WASO, at the expense of TiB and time spent in N1 and N2 sleep. As hypothesized, SWA increased robustly with TiB restriction across the 0.5–4 Hz range, as well as subjective sleep depth, subjective and objective WASO. Despite increases in sleepiness ratings, no impairments were found in memory acquisition or retention.A TiB restriction dose equivalent to 75% of habitual TiB robustly increased sleep continuity and SWA in older adults with sleep maintenance difficulties, without impairing memory performance. These findings may inform long-term behavioral SWA enhancement interventions aimed at improving memory performance and risk for cognitive impairments.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139389322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.3389/frsle.2023.1302021
Felice Di Laudo, L. Baldelli, G. Mainieri, G. Loddo, A. Montini, Caterina Pazzaglia, Monica Sala, F. Mignani, Federica Provini
Excessive daytime sleepiness is a symptom experienced by more than one-third of patients with Parkinson's disease and is associated with disease duration and severity, dopaminergic therapy, and several non-motor symptoms. In recent years, growing evidence has been suggesting “primary” sleepiness as a symptom in Parkinson's disease due to common pathophysiological features: for this reason, it is crucial to recognize sleepiness in these patients and to investigate and exclude other conditions possibly leading to sleepiness (e.g., heavy dopaminergic therapy or breathing disorders during sleep). For both inpatients and outpatients, the key to a correct diagnosis is a structured clinical interview, together with questionnaires, for a better characterization of symptoms and the use of objective measures as the most precise method to assess excessive daytime sleepiness. Finally, there are some therapeutical approaches that may be attempted for these patients, and although there is still no consensus on a standardized therapy, clinical trials with new drugs are currently persevered on.
{"title":"Daytime sleepiness in Parkinson's disease: a multifaceted symptom","authors":"Felice Di Laudo, L. Baldelli, G. Mainieri, G. Loddo, A. Montini, Caterina Pazzaglia, Monica Sala, F. Mignani, Federica Provini","doi":"10.3389/frsle.2023.1302021","DOIUrl":"https://doi.org/10.3389/frsle.2023.1302021","url":null,"abstract":"Excessive daytime sleepiness is a symptom experienced by more than one-third of patients with Parkinson's disease and is associated with disease duration and severity, dopaminergic therapy, and several non-motor symptoms. In recent years, growing evidence has been suggesting “primary” sleepiness as a symptom in Parkinson's disease due to common pathophysiological features: for this reason, it is crucial to recognize sleepiness in these patients and to investigate and exclude other conditions possibly leading to sleepiness (e.g., heavy dopaminergic therapy or breathing disorders during sleep). For both inpatients and outpatients, the key to a correct diagnosis is a structured clinical interview, together with questionnaires, for a better characterization of symptoms and the use of objective measures as the most precise method to assess excessive daytime sleepiness. Finally, there are some therapeutical approaches that may be attempted for these patients, and although there is still no consensus on a standardized therapy, clinical trials with new drugs are currently persevered on.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138944146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.3389/frsle.2023.1268967
Justin T. Matsuura, Nicole S. Keller, Michael B. Lustik, Carmen E. Campbell, Chad E. Grills
While the association between insomnia and traumatic brain injury (TBI) is well established, TBI rehabilitation programs that focus on sleep as a primary target are limited. Cognitive behavioral therapy for insomnia (CBTi) is an effective treatment for insomnia, however; its use within TBI clinics is relatively unknown. Therefore, our aim was to evaluate the implementation of CBTi, used in conjunction with a smartphone app for insomnia, within a US military TBI program to improve care within this setting.A TBI clinic at a US military installation.MHS beneficiaries underwent 6 sessions of CBTi and a 1-month post-treatment follow up session. Data was collected at each treatment session as part of routine clinical care.A total of 69 US MHS beneficiaries seen at a TBI clinic with a diagnosis of insomnia began CBTi. Attrition rate at the end of the CBTi program and 1-month posttreatment session was 35% and 48%, respectively. Results demonstrated that sleep onset latency (SOL) and wake after sleep onset (WASO) decreased during treatment (p's < 0.001). Further, symptoms reported on the Insomnia Severity Index (ISI) improved during CBTi (p < 0.001).Findings demonstrate how CBTi used in conjunction with a CBTi smartphone application can be used to effectively treat insomnia for MHS beneficiaries seeking care for TBIs. This evaluation provides the basis for further research on how CBTi may improve care within TBI programs.
{"title":"Cognitive behavioral therapy for insomnia in a military traumatic brain injury clinic: a quality improvement project assessing the integration of a smartphone application with behavioral treatment","authors":"Justin T. Matsuura, Nicole S. Keller, Michael B. Lustik, Carmen E. Campbell, Chad E. Grills","doi":"10.3389/frsle.2023.1268967","DOIUrl":"https://doi.org/10.3389/frsle.2023.1268967","url":null,"abstract":"While the association between insomnia and traumatic brain injury (TBI) is well established, TBI rehabilitation programs that focus on sleep as a primary target are limited. Cognitive behavioral therapy for insomnia (CBTi) is an effective treatment for insomnia, however; its use within TBI clinics is relatively unknown. Therefore, our aim was to evaluate the implementation of CBTi, used in conjunction with a smartphone app for insomnia, within a US military TBI program to improve care within this setting.A TBI clinic at a US military installation.MHS beneficiaries underwent 6 sessions of CBTi and a 1-month post-treatment follow up session. Data was collected at each treatment session as part of routine clinical care.A total of 69 US MHS beneficiaries seen at a TBI clinic with a diagnosis of insomnia began CBTi. Attrition rate at the end of the CBTi program and 1-month posttreatment session was 35% and 48%, respectively. Results demonstrated that sleep onset latency (SOL) and wake after sleep onset (WASO) decreased during treatment (p's < 0.001). Further, symptoms reported on the Insomnia Severity Index (ISI) improved during CBTi (p < 0.001).Findings demonstrate how CBTi used in conjunction with a CBTi smartphone application can be used to effectively treat insomnia for MHS beneficiaries seeking care for TBIs. This evaluation provides the basis for further research on how CBTi may improve care within TBI programs.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.3389/frsle.2023.1271827
M. Andersen, H. Hachul, I. Ishikura, S. Tufik
Sleep is a fundamental biological behavior that affects various aspects of health and wellbeing. However, there are some differences in respect of sleep between men and women. Notably, there are sex differences in relation to sleep problems and the potential comorbidities, such as diabetes and cardiovascular diseases, that are associated with these problems, with some evidence suggesting that women may have a greater predisposition to sleep disturbances. This narrative review provides a comprehensive analysis of the literature in respect of sex differences in the sleep, with the main focus being on women. Basic research has investigated sex-specific distinctions in sleep architecture, sleep quality, and circadian rhythms, while clinical studies have examined sex differences in sleep disorders, such as insomnia, sleep apnea, and restless leg syndrome. This narrative review also highlights the impact of the periods of hormonal fluctuations that occur across a woman's lifespan - such as during the menstrual cycle, pregnancy, and menopause phase - and examines their effects on sleep. It also explores the influence of social and cultural factors on sleep patterns in women. Taken together, the evidence suggests that women may be more susceptible to sleep disturbance, and that gender-specific factors should be considered when evaluating sleep in clinical practice. Further research is warranted to elucidate the mechanisms that underlie this and help guide the development of sex-specific interventions to improve sleep quality and promote holistic health in women.
{"title":"Sleep in women: a narrative review of hormonal influences, sex differences and health implications","authors":"M. Andersen, H. Hachul, I. Ishikura, S. Tufik","doi":"10.3389/frsle.2023.1271827","DOIUrl":"https://doi.org/10.3389/frsle.2023.1271827","url":null,"abstract":"Sleep is a fundamental biological behavior that affects various aspects of health and wellbeing. However, there are some differences in respect of sleep between men and women. Notably, there are sex differences in relation to sleep problems and the potential comorbidities, such as diabetes and cardiovascular diseases, that are associated with these problems, with some evidence suggesting that women may have a greater predisposition to sleep disturbances. This narrative review provides a comprehensive analysis of the literature in respect of sex differences in the sleep, with the main focus being on women. Basic research has investigated sex-specific distinctions in sleep architecture, sleep quality, and circadian rhythms, while clinical studies have examined sex differences in sleep disorders, such as insomnia, sleep apnea, and restless leg syndrome. This narrative review also highlights the impact of the periods of hormonal fluctuations that occur across a woman's lifespan - such as during the menstrual cycle, pregnancy, and menopause phase - and examines their effects on sleep. It also explores the influence of social and cultural factors on sleep patterns in women. Taken together, the evidence suggests that women may be more susceptible to sleep disturbance, and that gender-specific factors should be considered when evaluating sleep in clinical practice. Further research is warranted to elucidate the mechanisms that underlie this and help guide the development of sex-specific interventions to improve sleep quality and promote holistic health in women.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-28DOI: 10.3389/frsle.2023.1177878
K. Duraccio, Sarah L. H. Kamhout, Isabella Wright, K. Rugh, Jack Miskin, McKenna Amdal
Aspects of circadian sleep health including circadian alignment, circadian phase, or chronotype may be related to mental health outcomes in adolescents. Using novel and robust data collection methods, this study explored the relationship between adolescents' circadian sleep health and traits related to depression, anxiety, stress, and emotional regulation.Fifty-two healthy 14–18-year-olds (58% female; 94% European American) participated in this study. Across a 10-day period, participants completed wrist-worn actigraphy. Next, participants completed a dim-light melatonin onset (DLMO) protocol where 12 saliva samples were collected over a 6-h period to measure circadian phase. Circadian phase was calculated as the duration of time between DMLO to average sleep onset time across the monitoring period. Social jetlag was measured as the discrepancy between sleep times from weekday to weekend. Participants completed the Depression Anxiety Stress Scales (DASS-21), Emotion Regulation Questionnaire (ERQ), and the Morningness-Eveningness Questionnaire for Adolescents (MEQ). Following dichotomizing sleep outcomes into clinically relevant groups (late vs. early circadian phase, aligned vs. misaligned circadian rhythms, minimal social jetlag vs. presence of social jetlag, intermediate to morningness vs. eveningness chronotype), we conducted general linear models to determine circadian group differences in mental health outcomes (depression, anxiety, stress, expressive suppression, and cognitive reappraisal) while controlling for gender and pubertal development.Circadian phase had a large effect on depression symptoms in adolescents, with adolescents with later DLMO having significantly higher depression scores than those with earlier DLMO (p = 0.031). Chronotype had a medium but non-significant effect on anxiety and stress symptoms in adolescents, with adolescents with eveningness-tendencies having higher anxiety and stress symptoms than those with intermediate to morningness-tendencies (p's = 0.140 and 0.111, respectively).In the first ever study using gold-standard methodologies to examine the relationship between mental health and circadian sleep health in healthy adolescents, we observed that adolescents with later circadian phase had increased depressive symptoms compared to earlier circadian phase. Furthermore, adolescents who endorsed behaviors that suggest eveningness tendencies may have heightened stress/anxiety. These conclusions encourage future experimental research regarding this topic and may help inform interventions aimed to decrease depression, anxiety, and stress in adolescents.
{"title":"Multimodal assessment of circadian sleep health in predicting mental health outcomes in adolescents","authors":"K. Duraccio, Sarah L. H. Kamhout, Isabella Wright, K. Rugh, Jack Miskin, McKenna Amdal","doi":"10.3389/frsle.2023.1177878","DOIUrl":"https://doi.org/10.3389/frsle.2023.1177878","url":null,"abstract":"Aspects of circadian sleep health including circadian alignment, circadian phase, or chronotype may be related to mental health outcomes in adolescents. Using novel and robust data collection methods, this study explored the relationship between adolescents' circadian sleep health and traits related to depression, anxiety, stress, and emotional regulation.Fifty-two healthy 14–18-year-olds (58% female; 94% European American) participated in this study. Across a 10-day period, participants completed wrist-worn actigraphy. Next, participants completed a dim-light melatonin onset (DLMO) protocol where 12 saliva samples were collected over a 6-h period to measure circadian phase. Circadian phase was calculated as the duration of time between DMLO to average sleep onset time across the monitoring period. Social jetlag was measured as the discrepancy between sleep times from weekday to weekend. Participants completed the Depression Anxiety Stress Scales (DASS-21), Emotion Regulation Questionnaire (ERQ), and the Morningness-Eveningness Questionnaire for Adolescents (MEQ). Following dichotomizing sleep outcomes into clinically relevant groups (late vs. early circadian phase, aligned vs. misaligned circadian rhythms, minimal social jetlag vs. presence of social jetlag, intermediate to morningness vs. eveningness chronotype), we conducted general linear models to determine circadian group differences in mental health outcomes (depression, anxiety, stress, expressive suppression, and cognitive reappraisal) while controlling for gender and pubertal development.Circadian phase had a large effect on depression symptoms in adolescents, with adolescents with later DLMO having significantly higher depression scores than those with earlier DLMO (p = 0.031). Chronotype had a medium but non-significant effect on anxiety and stress symptoms in adolescents, with adolescents with eveningness-tendencies having higher anxiety and stress symptoms than those with intermediate to morningness-tendencies (p's = 0.140 and 0.111, respectively).In the first ever study using gold-standard methodologies to examine the relationship between mental health and circadian sleep health in healthy adolescents, we observed that adolescents with later circadian phase had increased depressive symptoms compared to earlier circadian phase. Furthermore, adolescents who endorsed behaviors that suggest eveningness tendencies may have heightened stress/anxiety. These conclusions encourage future experimental research regarding this topic and may help inform interventions aimed to decrease depression, anxiety, and stress in adolescents.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139226280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-27DOI: 10.3389/frsle.2023.1279903
Ivan Vargas, M. Egeler, Jamie L Walker, Dulce Diaz Benitez
Chronic insomnia is the most common sleep disorder, occurring in ~32 million people in the United States per annum. Acute insomnia is even more prevalent, affecting nearly half of adults at some point each year. The prevalence of insomnia among primary care patients is even higher. The problem, however, is that most primary care providers do not feel adequately knowledgeable or equipped to treat sleep-related concerns. Many providers have never heard of or have not been trained in cognitive behavioral therapy for insomnia or CBT-I (the first line treatment for insomnia). The focus of the current review is to summarize the factors contributing to why sleep health and insomnia treatment have been mostly neglected, identify how this has contributed to disparities in sleep health among certain groups, particularly racial and ethnic minorities and discuss considerations or potential areas of exploration that may improve access to behavioral sleep health interventions, particularly in primary care.
{"title":"Examining the barriers and recommendations for integrating more equitable insomnia treatment options in primary care","authors":"Ivan Vargas, M. Egeler, Jamie L Walker, Dulce Diaz Benitez","doi":"10.3389/frsle.2023.1279903","DOIUrl":"https://doi.org/10.3389/frsle.2023.1279903","url":null,"abstract":"Chronic insomnia is the most common sleep disorder, occurring in ~32 million people in the United States per annum. Acute insomnia is even more prevalent, affecting nearly half of adults at some point each year. The prevalence of insomnia among primary care patients is even higher. The problem, however, is that most primary care providers do not feel adequately knowledgeable or equipped to treat sleep-related concerns. Many providers have never heard of or have not been trained in cognitive behavioral therapy for insomnia or CBT-I (the first line treatment for insomnia). The focus of the current review is to summarize the factors contributing to why sleep health and insomnia treatment have been mostly neglected, identify how this has contributed to disparities in sleep health among certain groups, particularly racial and ethnic minorities and discuss considerations or potential areas of exploration that may improve access to behavioral sleep health interventions, particularly in primary care.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139231333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-15DOI: 10.3389/frsle.2023.1188424
Yng Miin Loke, Samantha Lim, A. V. Rukmini, Patricia Chen, John C. K. Wang, J. Gooley
Sleep problems frequently arise during adolescence and early adulthood and may contribute to the onset of depression. However, few sleep health instruments have been developed for use in student populations. Here, we developed a brief sleep health questionnaire for identifying adolescents and university students with sleep problems who may be at risk of depression.In Study 1, sleep survey data in adolescents (n = 1,733) were analyzed by best-subsets regression to identify the strongest predictors of self-reported depression symptoms: sleep quality, daytime sleepiness, self-rated health, frequency of staying up until 3:00 am, school day sleep latency, and gender. A 6-item Sleep Health And Wellness Questionnaire (SHAWQ) was developed using these items. Students were categorized into good, fair, and bad sleep health groups based on their composite SHAWQ scores. In Study 2, the SHAWQ was tested in adolescents (n = 1,777) for associations with depression symptoms and excessive daytime sleepiness. In Study 3, the SHAWQ was tested in university students (n = 2,040) for convergent validity with instruments for measuring sleep quality and insomnia severity, and for associations with major depressive disorder symptoms and anxiety disorder symptoms. Test-retest reliability was determined in a subset of 407 students who re-took the SHAWQ several weeks later. In Study 4, we tested whether SHAWQ scores in university freshmen (cohort 1, n = 1,529; cohort 2, n = 1,488) were prospectively associated with grade point average (GPA) over their first year.Across studies, SHAWQ scores were associated with higher depression and anxiety scores, excessive daytime sleepiness, lower sleep quality scores, and higher insomnia severity scores, demonstrating good convergent validity. Associations of SHAWQ scores with depression symptoms were stronger compared with anxiety symptoms. SHAWQ scores showed moderate test-retest reliability. Large effect sizes were observed for bad vs. good sleep health for all sleep and mental health variables. In both cohorts of university freshmen, students with bad sleep health had lower academic performance based on their GPA and percentile rank.Our findings suggest that the SHAWQ could be used to screen for students in their teens and twenties with bad sleep health who would benefit from counseling for sleep and mental health.
{"title":"Development and testing of the Sleep Health And Wellness Questionnaire (SHAWQ) in adolescents and university students: composite SHAWQ scores are associated with sleep problems, depression symptoms, and academic performance","authors":"Yng Miin Loke, Samantha Lim, A. V. Rukmini, Patricia Chen, John C. K. Wang, J. Gooley","doi":"10.3389/frsle.2023.1188424","DOIUrl":"https://doi.org/10.3389/frsle.2023.1188424","url":null,"abstract":"Sleep problems frequently arise during adolescence and early adulthood and may contribute to the onset of depression. However, few sleep health instruments have been developed for use in student populations. Here, we developed a brief sleep health questionnaire for identifying adolescents and university students with sleep problems who may be at risk of depression.In Study 1, sleep survey data in adolescents (n = 1,733) were analyzed by best-subsets regression to identify the strongest predictors of self-reported depression symptoms: sleep quality, daytime sleepiness, self-rated health, frequency of staying up until 3:00 am, school day sleep latency, and gender. A 6-item Sleep Health And Wellness Questionnaire (SHAWQ) was developed using these items. Students were categorized into good, fair, and bad sleep health groups based on their composite SHAWQ scores. In Study 2, the SHAWQ was tested in adolescents (n = 1,777) for associations with depression symptoms and excessive daytime sleepiness. In Study 3, the SHAWQ was tested in university students (n = 2,040) for convergent validity with instruments for measuring sleep quality and insomnia severity, and for associations with major depressive disorder symptoms and anxiety disorder symptoms. Test-retest reliability was determined in a subset of 407 students who re-took the SHAWQ several weeks later. In Study 4, we tested whether SHAWQ scores in university freshmen (cohort 1, n = 1,529; cohort 2, n = 1,488) were prospectively associated with grade point average (GPA) over their first year.Across studies, SHAWQ scores were associated with higher depression and anxiety scores, excessive daytime sleepiness, lower sleep quality scores, and higher insomnia severity scores, demonstrating good convergent validity. Associations of SHAWQ scores with depression symptoms were stronger compared with anxiety symptoms. SHAWQ scores showed moderate test-retest reliability. Large effect sizes were observed for bad vs. good sleep health for all sleep and mental health variables. In both cohorts of university freshmen, students with bad sleep health had lower academic performance based on their GPA and percentile rank.Our findings suggest that the SHAWQ could be used to screen for students in their teens and twenties with bad sleep health who would benefit from counseling for sleep and mental health.","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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