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Objective To investigate whether capnometry-assisted antihyperventilation respiratory training, successful in treating panic, and sleep hygiene instructions would reduce posttraumatic stress disorder (PTSD) hyperarousal symptoms in U.S. military veterans. Method We conducted a parallel, nonblinded clinical trial and randomized 80 veterans with PTSD hyperarousal into treatment or wait list. Primary treatment outcomes from baseline to 1st follow-up were analyzed using mixed modeling. Baseline physiological measures were compared between the PTSD hyperarousal group and a no-PTSD group (n = 68). Results Baseline respiration rate but not partial-pressure of end-tidal carbon dioxide (PCO₂) was higher in the PTSD hyperarousal group than in the no-PTSD group during 3 min of quiet sitting, indicating no difference in baseline hyperventilation. There was no significant effect of the intervention on PTSD hyperarousal symptoms or hyperventilation compared to wait list, but treatment did lower respiratory rate. Conclusion This intervention did not reduce PTSD hyperarousal symptoms, perhaps due to differences between underlying mechanisms of PTSD hyperarousal and panic disorder or to differences between veteran and civilian populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Summary Objectives The objectives of this study were to evaluate the duration and the quality of sleep, as well as daytime sleepiness, among different levels of Arab athletes (i.e., amateur, elite) and to compare sleep quality and duration and daytime sleepiness in athletes and sedentary individuals. Material and methods A total of 409 participants, characterized as elite athletes (n = 78), amateur athletes (n = 231), and sedentary individuals (n = 100), participated in this study. Participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire, for the evaluation of sleep quality, and the Epworth Sleepiness Scale (ESS), for the assessment of daytime sleepiness. Results The total PSQI score was significantly higher in sedentary (total PSQI score = 5.74 ± 2.5) vs. amateur (total PSQI score = 5 ± 2.3) (P 0.05). There was no significant difference (P > 0.05) between levels of daytime sleepiness reported in amateur athletes (ESS score = 9.6 ± 4.3), elite athletes (ESS score = 10 ± 3.8), and sedentary individuals (ESS score = 10.4 ± 2.4). Conclusion Athletes experienced a better sleep quality compared to sedentary individuals. However, some athletes can suffer from poor sleep quality, suggesting an urgent need for the implementation of sleep hygiene education. Levels of daytime sleepiness, comparable in athletes and sedentary individuals, indicate higher normal daytime sleepiness. Thus, daily naps could be useful to prevent excessive daytime sleepiness, but future studies on this topic, efficacy, and practicality are needed.

STUDY OBJECTIVES: Empirical evidence linking individual sleep hygiene practices to subsequent sleep parameters is limited, particularly at the daily level. This study compared the strength of daily, within-person associations between these modifiable sleep behaviors and nighttime sleep in young adult drinkers with insomnia. METHODS: Young adults (ages 18–30 years; n = 56) who met diagnostic criteria for insomnia and reported past-month binge drinking wore wrist actigraphy and completed online sleep diaries for 8.5 days (standard deviation = 2.3; 477 reports). Diaries assessed engagement in 11 sleep hygiene recommendations. Multilevel models tested daily associations between sleep behaviors and 3 outcomes: sleep quality, self-reported sleep efficiency, and actigraphy-measured sleep efficiency. RESULTS: Participants self-reported better sleep quality/efficiency on days that they slept in a comfortable environment, limited naps to 30 minutes, and maintained a consistent wake time. They self-reported worse sleep quality and efficiency on nights that they avoided alcohol use before bedtime. No sleep behaviors were significantly associated with actigraphy-measured sleep efficiency after correcting for inflation in type I error. CONCLUSIONS: The sleep hygiene recommendations most strongly associated with sleep at the daily level were consistent with stimulus control. Creating a comfortable sleep environment also emerged as an important correlate of daily sleep. Heavy drinkers with insomnia may perceive better sleep if they drink before bedtime; however, this finding may be unique to this population. CITATION: Miller MB, Curtis AF, Hall NA, et al. Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia. J Clin Sleep Med. 2022;18(3):703–712.

The primary objective of this pilot randomized controlled trial was to study the feasibility (recruitment and retention rates) for interval training and sleep hygiene (SH) in adults aged above 60 years. Thirteen out of 46 screened individuals from a home for older adults in Shirdi (Maharashtra, India) were randomly assigned by permuted block randomization to either an interval training with SH group (n = 6) or an SH alone group (n = 7). The authors measured sleep with the S+ sleep monitor manufactured by ResMed (USA) Pittsburgh Sleep Quality Index and quality of life with Short Form-12 health survey version 2. Interval training consisted of 8 weeks of stationary cycling, whereas SH consisted of lecture and handouts. Recruitment was 38.2%, retention was >80% for both the interventions, and there was one loss to follow-up in SH. Interval training and SH were feasible for older adults and supported a full-scale randomized controlled trial.

Objective The objective of this study was to assess the impact of meditation on insomnia and other menopausal symptoms experienced by working women during the menopausal transition period. Method A randomized clinical trial was conducted with 47 women between the ages of 40 and 55 who worked in three of the National Institute of Social Security units, in the city of Sao Paulo, Sao Paulo, Brazil. Participants were randomized into two groups: an intervention group, who practiced Raja Yoga Meditation and Sleep Hygiene - M + SH (n = 18); and a control group, who practiced only Sleep Hygiene - SH (n = 15) during a period that went from April to July 2013. Eight weekly meetings were held with the participants of both groups. Menopausal symptoms and sleep disturbances were the outcomes analyzed. Results In relation to the intensity of the insomnia symptom, improvement in relation to time was observed in both groups (M + SH p = 0.001) (SH p = 0.005). The intervention group showed a significant improvement in KMI index (p = 0,024). The control group showed improvement in PSQ total score (p = 0,016). In the comparison between groups ANOVA two-way test showed significant difference (0,026) in KMI, demonstrating that meditation can be relevant for the decrease of climatic symptoms. Conclusion The results suggest that Raja Yoga meditation may be a non-pharmacological alternative in the control of sleep quality and menopause associated symptoms during late menopausal transition, contributing to the improvement of working women’s quality of life. Registered in the Brazilian Clinical Trials Platform UTN: U1111−1136-0744.

Parkinson’s disease is characterized mainly by damage to the neurons of the substantia nigra and other brain structures and manifested by motor and non-motor symptoms. In patients with Parkinson’s disease receiving dopaminergic therapy, a later onset of sleep has been identified that is associated with the development of the delayed sleep phase disorder. The delayed sleep phase disorder is characterized by a persistent delay in the circadian rhythm that causes a delay in the desired time of falling asleep and waking up. According to clinical guidelines for the treatment of delayed sleep phase disorder, exogenous melatonin is recommended. Along with this, its analgesic properties have been reported. At the same time circadian regulation of fluctuations of painful sensations transmission by either peripheral or central alarm system has been reported. In particular, the two-way connection between the nociceptive system and the circadian rhythm in the human body determines the possibility of mutual influence between these systems. However, the question of the therapeutic effect of melatonin in the presence of concomitant pathology on the circadian rhythm disorders, and, in particular, delayed sleep phase disorder that is a topical issue for patients with Parkinson's disease, is still remaining unexplored. The aim of the study is to compare the changes in subjective perception of pain in patients with Parkinson's disease, who received melatonin therapy and who did not, in delayed sleep phase disorder. We conducted a prospective study that included 48 patients with Parkinson's disease. Circadian rhythm disorders were diagnosed according to the criteria of the International Classification of Sleep Disorders-3. The diagnosis of delayed sleep phase disorder was made on the basis of a clinical interview, filling in a sleep diary and daily thermometry for 7 days. The examined patients were divided into 2 groups according to the chosen method of treatment: group 1 - patients with Parkinson's disease and delayed sleep phase disorder receiving melatonin; group 2 - patients with Parkinson's disease and delayed sleep phase disorder receiving only general recommendations for improving sleep quality and daily functioning without medical intervention. The Unified Parkinson's Disease Rating Scale was used to assess the severity of patients’ clinical condition. The intensity of the pain syndrome was assessed on a visual-analogue scale. The McGill Questionnaire was used to analyze subjective experiences of pain. The patients of group 1 were prescribed to take melatonin, 1 tablet in a dose of 3 mg at 22:00. Individuals in group 2 received general recommendations on the schedule of sleep-wake cycles, light regime and sleep hygiene. Patients with Parkinson's disease and delayed sleep phase disorder have been diagnosed with mild to moderate pain. Treatment of delayed sleep phase disorder in patients with Parkinson's disease reduces the intensity and modality of the pain syndrome, which may be due to improved functioning of the descending pain modulation system and restoration of rhythmic expression of internal clock genes. The administration of melatonin as part of a comprehensive approach to the treatment of circadian rhythm disorders helps to reduce sensory sensations and affective experiences caused by pain that indicates the potential antinociceptive effect of melatonin in the treatment of circadian disorders.

Resistance training (RT) is well tolerated and has shown promise for decreasing fatigue. However, the effects of RT have never been examined in primary Sjogren’s syndrome (pSS). To assess the feasibility, effectiveness, and safety of a resistance exercise program on fatigue in patients with pSS. This is a parallel, single-blind randomized trial. Women aged 18 years or older, diagnosed with pSS according to the American-European criteria, were included. We randomized 59 participants to a resistance training group (RT) or a control group (CG). Participants in the RT group performed a 16-week resistance exercise program. The sessions consisted of three sets of resistance exercises (10 repetitions each) at 60 to 80% of 1 repetition maximum, designed to improve whole-body strength. The participants in the CG received their usual pharmacological treatment and instructions regarding disease control, pain management, sleep hygiene, and activities of daily living. To compare intergroup and intragroup variability, a one-factor repeated-measures analysis of variance (ANOVA) was used. RT effectively improved fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease activity by the patient. No between-group differences were found in the ESSPRI mental score, ESSDAI, SF-36-Physical Aspects, SF-36-General Health, SF-36-Social aspects, and SF-36-Mental Health after the training period. An RT program was safe and effective in improving fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease activity by the patient in women with pSS.

Objective To describe pharmacological and non-pharmacological practices for delirium, carried out by psychiatry residents and psychiatrists in Colombia. Methods An anonymous survey was conducted based on the consensus of experts of the Liaison Psychiatry Committee of the Asociacion Colombiana de Psiquiatria [Colombian Psychiatric Association] and on the literature review. It was sent by email to the association members. Results 101 clinicians participated. Non-pharmacological preventive measures such as psychoeducation, correction of sensory problems or sleep hygiene are performed by 70% or more. Only about 1 in 10 participants are part of an institutional multi-component prevention programme. The preventive prescription of drugs was less than 20%. Regarding non-pharmacological treatment, more than 75% recommend correction of sensory difficulties, control of stimuli and reorientation. None of the participants indicated that the care at their centres is organised to enhance non-pharmacological treatment. 17.8% do not use medication in the treatment of delirium. Those who use it prefer haloperidol or quetiapine, particularly in hyperactive or mixed motor subtypes. Conclusions The practices of the respondents coincide with those of other experts around the world. In general, non-pharmacological actions are individual initiatives, which demonstrates the need in Colombian health institutions to commit to addressing delirium, in particular when its prevalence and consequences are indicators of quality of care.

Patients with chronic non-specific low back pain (CNSLBP) often have sleep disturbances (insomnia), which negatively affects pain severity, mental state, activities of everyday living, and the overall quality of life. The prevalence of insomnia in patients with CNSLBP and the effectiveness of its therapy require further investigation.Objective: to identify the prevalence of insomnia and the effectiveness of its treatment in CNSLBP.Patients and methods. The study included 71 patients aged 18–75 years (mean age 55.09±13.0 years) with CNSLBP. A single sleep hygiene educational session was run in the standard treatment group (n=34; mean age – 51±14 years). Intervention in the extended therapy group (n=37; mean age – 59±12 years) included an educational program dedicated to sleep, which was an individual face-to-face course of 4–5 sessions over two weeks and a telephone survey after three months. We used the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbances, a numerical rating scale (NRS) to assess pain, the International Physical Activity Questionnaire (IPAQ-SF), and the 12-item short form health survey (SF-12) to assess physical activity and quality of life. The survey was carried out three times (at the admission, after 7–10 and 80–90 days).Results and discussion. In both groups of patients with CNSLBP, PSQI scores improved in a week and after 3 months compared with baseline (pth and 90th days significantly improved only in the extended therapy group (p=0.025). ISI scores significantly improved during inpatient treatment in both groups (pth and 90th days significantly improved only in the extended therapy group (р=0.048). Back pain intensity according to NRS significantly decreased in a week and after 3 months, compared to baseline (рConclusion. Most patients with CNSLBP have insomnia, the treatment of which can improve sleep and help reduce pain.

Background Oncology nurses are at increased risk for developing burnout. Although various interventions have been researched, mindfulness has been proven to be beneficial in mitigating burnout while improving well-being. Objectives The aim was to evaluate whether the use of a mindfulness mobile application (app), Headspace®, increases perceptions of well-being and decreases perceptions of burnout among inpatient bone marrow transplantation (BMT) staff nurses and nurse practitioners (NPs). Methods This evidence-based practice quality improvement initiative introduced the Headspace app to BMT nurses and evaluated its impact on burnout and well-being at baseline and every 30 days for 90 days. Findings There were significant improvements in burnout and well-being in staff nurses and NPs from baseline to each time point. Sleep hygiene meditations were the most widely used programs within the Headspace app for both nursing groups.

Introduction: Sleep hygiene therapy is a non- pharmacological therapy that can be done by nurses in providing nursing actions to schizophrenic patients. Methods: The design of this research is Pre- Experimental Design in the form of One-Group Pretest-Postest Design. The sampling technique used purposive sampling with a total of 15 respondents Results: The results of the analysis showed that there were differences in the sleep quality of schizophrenic patients before and after sleep hygiene therapy which was indicated by the results of the Paired Sample T- Test analysis where the significance results were p value = 0.000

Objective: The study was conducted to determine the relationship between health-promoting lifestyle behaviors and sleep quality of nurses working in the pediatrics clinics. Methods: The study was conducted among nurses working in the pediatrics clinic of a training and research hospital located in Istanbul. Nurse Information Form, Health-Promoting Lifestyle Profile-II (HPLP-II), and Pittsburg Sleep Quality Index (PSQI) were applied to the nurses. Ethics committee and institutional permission, permission from the scale authors via e-mail, and written consent from the nurses were obtained in the study.Besides the descriptive statistics, Mann Whitney U test, Kruskal Wallis test, and Spearman's Rho Correlation analysis were used for the analysis of the study. Results: Among the 200 nurses that were surveyed, 121 (60.5%) responded.81% of the nurses (n=98) were female, and 80.2% had a bachelor's degree. Age average of the nurses was 25.74 +/- 3.86 years and the average weekly working hours was 49.40 +/- 7.70 hours. It was determined that total mean score of HPLP-II was 125.26 +/- 16.40 and PSQI total mean score was 12.13 +/- 2.29. The lowest mean HPLP-II subscale score was 16.19 +/- 4.64 for exercise and 17.71 +/- 3.74 for stress management. A statistically significant correlation was found between the HPLP-II total scores and PSQI total scores (r= - 0.19; p< 0.05). Conclusion: It was determined that the health-promoting lifestyle behaviors of the nurses were above the moderate level, their sleep quality was poor, and there was a significant correlation between the health-promoting lifestyle behaviors and the sleep quality of the nurses. It can be suggested by nursing to conduct the studies determining the practices that will improve the health-promoting lifestyle behaviors of the nurses and enhance their sleep quality.

Research on Hispanic sleep (1) remains far behind research on non-Hispanic White sleep, and (2) seldom focuses solely on Hispanic women. A convergent parallel mixed-methods study design was used to examine (1) sleep quantity, quality, and habits; (2) the association of sleep and health; and (3) perceived barriers to healthy sleep in middle-aged Hispanic women living in [a large Midwest city]. A total of 78 Hispanic women were surveyed, and 27 of these Hispanic women participated in focus groups. Participants had: poor sleep quantity, quality, and sleep hygiene. In focus groups, participants identified three barriers to healthy sleep: poor sleep hygiene, responsibilities and related stress, and additional mental health concerns. While poor sleep quantity and quality have serious health consequences for Hispanic women, sleep disorders in Hispanic women have been understudied. This study underscores barriers to healthy sleep and the associations between sleep and health in Hispanic women.

Postural orthostatic tachycardia syndrome (POTS) is often seen in clients with Ehlers-Danlos syndrome (EDS), primarily hypermobile EDS. Research has shown clients with EDS and POTS may experience limitations affecting not only their physical function, but also their social, emotional, and mental well-being. Using a client-centered approach, occupational therapy practitioners assess health, well-being, symptomatology (fatigue, muscle pain, dizziness, etc.), participation and engagement in occupation, and provide interventions to improve quality of life. This paper will address occupational therapy interventions to treat common symptomatology for clients with EDS in the presence of POTS, including environmental modifications, use of adaptive equipment and orthoses, exercise and fall prevention, energy conservation and pacing, sleep hygiene, and routine and habit development to promote optimal engagement in meaningful occupations.

Sleep hygiene recommendations discourage eating before bedtime; however, the impact of mealtime on sleep has been inconsistent. We examined gender-stratified associations between eating or drinking 30 min). This study utilised 2003–2018 data from the American Time Use Survey, a nationally representative sample of USA residents aged ≥15 years. Participants recorded weekday/weekend activities during a 24-h period. Age-specific sleep duration and WASO were estimated categorically and continuously. Eating or drinking were identified from all activities recorded se sleep duration was 8·0 ± 0·006 h, and 6% of participants ate or drank v. those who did not, had 35 min (95% CI (30,39)) and 25 min (95 % CI (21,29)) longer sleep duration, respectively, as well as increased odds of WASO; women (OR=2·03, 95% CI (1·66,2·49)) and men (OR=2·64, 95% CI (2·08,3·36)). As the interval of eating or drinking prior to bedtime expanded, odds of short and long sleep durations and WASO decreased. This population-based data linked eating or drinking

Aim. To investigate the effectiveness of the short-term protocol of cognitive behavioral therapy RELEGS M. Hornyak et al. in complex treatment to improve the quality of sleep, reduce the symptoms of depression, anxiety, suicidal thoughts in patients with primary SBN comorbid with chronic insomnia. Methods. Study participants: 68 patients with primary restless legs syndrome with comorbid chronic insomnia. Women 56 (average age 52.110.3 years), men 12 (average age 50.39.4 years). The severity of restless legs syndrome is moderate to severe. The average age of the onset of the disease is 1848 years, the duration of the course of the disease is on average 1415 years. Taking various medications for the management of SBN for an average of 45 years. Study design: a randomized controlled trial, after screening 26 patients were assigned to the main group, underwent combined treatment, took a prolonged form of Pramipexole (Mirapex-PD, 1.5 mg.) and underwent the RELEGS CBT protocol (Restless Legs Skills program, Hornyak, Grossmann, 2018), which integrates the cognitive behavioral insomnia protocol (Morin, 2007) and Mindfulness-Based Stress therapy (Mindfulness-Based Stress Reduction, Bablas, 2016). The control group consisted of 24 people who received only general recommendations on sleep hygiene once. Both groups were treated with dopaminergic agonists under the supervision of a neurologist. Research methods: IRLS, ISI, DBAS-16, sleep diary analysis, actigraphy, BDI, SBQ-R, BAI. Results. The use of the CBT protocol in combination therapy with prolonged-acting dopaminergic agonists in patients with primary restless leg syndrome (mild and moderate severity) with comorbid chronic insomnia, in contrast to simple one-time general recommendations on sleep hygiene, is more effective for reducing dysfunctional behaviors, the spectrum of reinsurance and avoidance behavior both in relation to sleep and symptoms of restless legs. In patients with primary restless legs syndrome who underwent CBT, greater mental well-being was observed, which was expressed in a decrease in the severity of symptoms of insomnia, anxiety, and suicidal behavior after completion and persisted after 3 months of follow-up. Conclusion. As part of a personalized comprehensive approach, along with a drug-based approach and general recommendations for sleep hygiene, the use of short-term CBT (4 sessions, 60 minutes each) can significantly improve mental well-being, improve the quality of sleep of patients with restless legs syndrome with comorbid chronic insomnia.

Objective: A good sleep quality is essential for biopsychosocial health. Studies show that most high school students have poor sleep quality, and recently, nomophobia has also become common in high school students. This study aims to determine the factors affecting sleep quality and its relationship with nomophobia among high school students. Materials and Methods: This cross-sectional study was conducted in 428 high school students. Pittsburgh sleep quality index and nomophobia scale were used for data collection. Factors affecting sleep quality were evaluated with both univariate and multivariate logistic regression analyses. Results: The sleep quality in 65.7% of students was poor. Poor sleep quality was found to be increased by 1.70 (1.04-2.81) times in females;6.82 (2.65-17.55) times in those having flu or other upper respiratory tract infections;3.17 (1.50-6.68) times in those with gastrointestinal disorders;4.40 (1.48-13.10) times in those overweight;and 2.99 (1.36- 6.57) times in those with severe nomophobia (p

STUDY OBJECTIVES: Prior studies have suggested a benefit of yoga for alleviating sleep disturbance; however, many studies have had methodological limitations. This trial study aimed to extend that literature by including an active sleep hygiene comparison. METHODS: Participants aged 25–59 years with a primary complaint of sleep onset insomnia lasting at least 6 months were block randomized to an 8-week Kundalini yoga or sleep hygiene intervention, both consisting of initial 60-minute instruction and weekly check-ins. Daily sleep diaries and questionnaires were collected at baseline, throughout the intervention, and at 6-month follow-up. Data were analyzed using linear mixed models (n = 20 in each group). RESULTS: Participant ratings of the interventions did not significantly differ. Sleep hygiene improved several diary and questionnaire outcomes, however, yoga resulted in even greater improvements corresponding to medium-to-large between-group effect sizes. Total sleep time increased progressively across yoga treatment (d = 0.95, P = .002), concurrent with increased sleep efficiency (d = 1.36, P < .001) and decreased sleep onset latency (d = −1.16, P < .001), but without changes in pre-sleep arousal (d =−0.30, P = .59). Remission rates were also higher for yoga compared to sleep hygiene, with ≥ 80% of yoga participants reporting average sleep onset latency < 30 minutes and sleep efficiency > 80% at 6-month follow-up. For over 50% of yoga participants, the insomnia severity index decreased by at least 8 points at end of treatment and follow-up. CONCLUSIONS: Yoga, taught in a self-care framework with minimal instructor burden, was associated with self-reported improvements above and beyond an active sleep hygiene comparison, sustained at 6-month follow-up. Follow-up studies are needed to assess actigraphy and polysomnography outcomes, as well as possible mechanisms of change. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Yoga as a Treatment for Insomnia; URL: https://clinicaltrials.gov/ct2/show/NCT00033865; Identifier: NCT00033865. CITATION: Khalsa SBS, Goldstein MR. Treatment of chronic primary sleep onset insomnia with Kundalini yoga: a randomized controlled trial with active sleep hygiene comparison. J Clin Sleep Med. 2021;17(9):1841–1852.

Background Sleep is a natural physiological process vital for the physical and mental wellbeing of pregnant women and their fetuses. Even though poor sleep quality is a common problem among pregnant women, it is not studied in developing countries including Ethiopia. Therefore, this study was aimed to assess the poor sleep quality and associated factors among pregnant women attending antenatal care at Jimma medical center, Jimma, Southwest Ethiopia, 2020. Methods A cross-sectional study design was conducted among 415 pregnant women at Jimma Medical Center (JMC). The study subjects were selected using a systematic random sampling technique. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality using face-to-face interviews. SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to sleep quality. In multivariable logistic regression variables with a p-value less than 0.05 was considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. Results The prevalence of poor sleep quality among pregnant women was found to be 30.8% (95% CI (26.5, 35.2). In multivariable analysis, age ≥ 30 years old (AOR = 1.94;95%CI:1.03,3.66), Multigravida (AOR = 1.90;95%CI:1.90,3.32),depression (AOR = 4.26;95%CI:2.54,7.14),stress (AOR = 1.85;95%CI:1.20,3.02) were variables significantly associated with poor sleep quality. Conclusion This study found a high prevalence of poor sleep quality among pregnant women. Older age, gravidity, depression, and stress were associated with poor sleep quality. It is better to have routine sleep pattern screening and teach sleep hygiene practice for pregnant women.

Objective Adolescents and young adults in the college setting often report poor sleep hygiene and quality. These sleep difficulties may be related to emotion dysregulation, which is highly relevant to broader adjustment. The current study aimed to empirically identify latent groups of healthy college students with distinct subjective sleep patterns and examine differences in emotion dysregulation between subgroups. Methods College students (N = 476; Mage=19.38) completed the Adolescent Sleep–Wake Scale—Revised, Adolescent Sleep Hygiene Scale—Revised, and Difficulties in Emotion Dysregulation Scale. Most participants were White (78%), non-Hispanic/Latinx (85%), and female (77%). Latent profile analysis identified patterns of sleep with maximum likelihood estimation. Bolck–Croon–Hagenaars procedure evaluated differences in emotion dysregulation by class. Results A three-class model had optimal fit, Bayesian information criterion = 11,577.001, Bootstrapped Parametric Likelihood Ratio Test = −5,763.042, p Conclusions Emotion dysregulation differed across three sleep profiles, with participants classified in the good sleep group reporting, on average, the lowest emotion dysregulation, compared to the moderate and poor sleep groups. These findings highlight contextual factors of sleep that may be clinically targeted to promote emotion regulation.

A clinical case of a patient with chronic nonspecific low back pain and comorbid chronic insomnia is described, and a modern approach to the management of this patient category is shown. So-called yellow flags - factors that contribute to the central sensitization of pain - lead to chronicity of LBP. In the presented clinical case we identified the most common "yellow flags”: insomnia, pain catastrophizing, restrictive ”pain” behavior, anxiety. In practice, they often ignore the aforementioned factors, determine only the presence of back pain and prescribe analgesic therapy, which does not allow for an effective result.Insomnia is prevalent among patients with LBP, occurring in 47-64% of cases. With the COVID-19 pandemic among the population, the incidence of insomnia, anxiety and depression has increased. To date, the identification and treatment of these disorders is particularly relevant in the management of patients with chronic nonspecific LBP.The patient was treated, which included non-drug and drug methods and complied with Russian and foreign clinical guidelines on the therapy of chronic nonspecific LBP and on the therapy of chronic insomnia. Non-drug treatment consisted of educational talks, recommendations on daily activity and sleep hygiene, cognitive-behavioral therapy, mindfulness, relaxation, and therapeutic gymnastics. The listed methods were aimed at reducing pain catastrophizing, physical and social activation of the patient. The nonsteroidal anti-inflammatory drug dexketoprofen was used as pharmacotherapy according to a step-by-step regimen. After 5 days of therapy pain relief was observed, after 3 months of therapy back pain regressed, sleep normalized, mood improved. This therapeutic approach showed its effectiveness and safety in the treatment of chronic nonspecific LBP and comorbid chronic insomnia.

BACKGROUND CONTEXT The relationship between biopsychosocial factors (the interaction of biologic factors, behavioral factors, and social factors that affect overall health) and quality of life is well established in spine surgery patients. Sleep hygiene is an important component of wellbeing and is closely linked to mental health. Despite the importance of sleep hygiene and the strong association between poor sleep and mental health disorders, little is known about how sleep disturbance (SD) in patients with spine conditions correlates with validated health-related quality-of-life (HRQOL) measures or the degree to which SD changes after surgery. PURPOSE Our objectives were to determine the (1) prevalence of SD among patients presenting for spine surgery at a large academic medical center; (2) correlation between SD and HRQOL scores; and (3) association between postoperative SD resolution and short-term HRQOL. We hypothesized that SD would be significantly correlated with HRQOL in patients undergoing elective spine surgery. In addition, we hypothesized that postoperative resolution of SD would be significantly associated with improved HRQOL. STUDY DESIGN/SETTING The current study is a retrospective review of these prospectively collected data from patients who presented for spine surgery at an academic medical center. PATIENT SAMPLE Eligible patients were English-speaking, were aged 18 years or older, had undergone elective surgery for degenerative lumbar or cervical spine disease or for correction of spinal deformity, and had completed preoperative and immediate postoperative assessments. Of 1,193 patients enrolled, we included the 508 (43%) who met our inclusion criteria. Of these, 226 (44%) had complete 1-year follow-up. Participants’ mean age was 60 years (standard deviation, 13 years), and most were non-Hispanic (98%), and White (73%). All participants were treated at the same center by 5 fellowship-trained, board-certified spine surgeons with 6–26 years in practice. We found no significant differences in age (P = 0.98), sex (P = 0.73), or prevalence of SD (P = 0.17) between included and excluded patients. OUTCOME MEASURES Participants completed an assessment before surgery of sociodemographic and clinical information. Sociodemographic information comprised age, sex, race/ethnicity, highest educational attainment, annual household income, and relationship status. Highest educational attainment was categorized as less than 4-year college degree; 4-year college degree; or post-graduate degree. Annual household income was categorized as $80,000. Relationship status was used to determine whether a participant lived alone or with a partner. Clinical information was presence of comorbid conditions, current use of opioid medication, and presence of intraoperative and/or postoperative complications. Participants completed assessments of their health and wellness before and after surgery. After surgery, assessments were completed during the immediate postoperative period (6–12 weeks) and at 6, 12, and 24 months. These assessments were the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI) and the Patient-Reported Outcome Measurement Information System (PROMIS-29) health domains. METHODS Using preoperative PROMIS SD scores, we grouped participants as having no sleep disturbance (score RESULTS Preoperative SD was reported by 127 participants (25%). SD was significantly correlated with worse ODI/NDI values and worse scores in all PROMIS health domains (all, P CONCLUSIONS One-quarter of spine surgery patients reported preoperative SD of at least moderate severity. Poor preoperative sleep quality and ongoing postoperative sleep disturbance were significantly associated with worse scores on several HRQOL measures. These results highlight the importance of addressing patients’ sleep disturbance both before and after surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Insomnia can have significant health and economic impacts. In contrast, sleep disturbance is common but does not usually affect daytime activity Short-term approaches for acute insomnia are often appropriate. These include dealing with precipitating factors such as stress Chronic insomnia has a high relapse and recurrence rate. It is best managed with cognitive behavioural therapy which includes sleep hygiene, stimulus control and sleep restriction In primary care, brief behavioural therapy for insomnia is an accessible and effective management strategy. If there is no response, referral should be considered Adjuvant use of drugs in insomnia may be appropriate in some cases. Prescription should be for a limited duration

Karla Moreno-Tamayo,1 Betty Manrique-Espinoza,2 Selene Guerrero-Zúñiga,3 Eliseo Ramírez-García,1 Sergio Sánchez-García1 1Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México; 2Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México; 3Unidad de Medicina del Sueño, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, MéxicoCorrespondence: Sergio Sánchez-GarcíaUnidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc No. 330, Edificio CORCE, Tercer piso. Col. Doctores, Alcaldía Cuauhtémoc, Ciudad de México, 06720, MéxicoTel + 52 556276900 Ext. 21846Email sergio.sanchezga@imss.gob.mxPurpose: To analyze the association between risk of obstructive sleep apnea (OSA), insomnia, sleepiness and self-assessed sleep duration with frailty in older adults.Patients and Methods: Cross-sectional study with 1643 older adults (60 to 97 years old) who participated in round 6 (2019) of the Cohort of Obesity Sarcopenia and Obesity in Older Adults of the Mexican Institute of Social Security. The Berlin Questionnaire was used to assess risk of OSA, the Athens Insomnia Scale for insomnia, the Epworth Scale for sleepiness, and sleep duration by self-report. Frailty was assessed with the frailty criteria proposed by Fried. Sociodemographic and health variables were also collected. Statistical analysis was performed with logistic regression and was stratified by sex.Results: This study included 1643 participants (823 men and 820 women). Mean age was 67.1 ± 5.9 years. The percentage of frail older adults was 10.5% (n = 172), with risk of OSA 26.1% (n = 429), with insomnia 30.3% (n = 497) and with sleepiness 18.9% (n = 310). In all participants, risk of OSA and insomnia were associated with frailty. In the stratified analysis by sex, the association between risk of OSA and frailty was observed in women (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.05, 3.22), but not in men (OR = 1.19, 95% CI: 0.65, 2.19). Insomnia was significantly associated with frailty in women (OR = 2.38, 95% CI: 1.35, 4.20) and in men (OR = 1.88, 95% CI: 1.01, 3.52). Neither sleepiness nor sleep duration was associated with frailty.Conclusion: In community-dwelling older adults, both the risk of OSA and insomnia conferred greater odds of presenting frailty in women. It is required to implement strategies aimed at improving sleep hygiene and detecting patients with OSA and insomnia.Keywords: sleep disorders, obstructive sleep apnea, older adults, insomnia disorder, sleepiness

BackgroundHigh prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels.MethodsUsing a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions.ResultsThe prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%,p ConclusionChildren with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors.Trial registrationThe study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number:ChiCTR2000031194).

Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [ Journal of Gerontological Nursing, 47 (8), 29–35.]

Background Assess if changes in sleep quality (Sleep Quality Index, SQI) based on cardiopulmonary coupling-analysis (CPC) impacts serum adiponectin-levels in patients with cardiovascular disease (CVD). Methods Secondary analysis of electrocardiogram (ECG) data from the Heart Biomarker Evaluation in Apnea Treatment study (HeartBEAT), a multicenter, controlled trial in patients with CVD and moderate-severe sleep apnea, randomly assigned to intervention of Continuous Positive Airway Pressure (CPAP), Nocturnal Supplemental Oxygen (NSO) or Healthy Lifestyle and Sleep Hygiene Education (HLSE; control group). Participants with good-quality ECG-signal (n = 241) were included. Results Improving CPC-sleep quality was associated with net average improvements in serum adiponectin-levels 2.69 μg/ml (p = 0.005) irrespective of therapy initiated. After controlling for confounders, a unit increase in SQI was associated with increase in serum adiponectin-levels 0.071 μg/ml (p = 0.012) and decrease in insulin-levels 0.197 μIU/ml (p = 0.0018). Similarly, a percentage point increase in sleep apnea indicator (SAI) was associated with decrease in serum adiponectin-levels of 0.071 μg/ml (p = 0.017) and increase in insulin-levels of 0.218 μIU/ml (p = 0.020). A percentage point increase in CPC-sleep fragmentation (eLFCBB) had a predicted increase in glucose-levels 0.371 mg/dl (p = 0.009) and insulin-levels 0.284 μIU/ml (p = 0.010). In patients receiving CPAP-therapy, a difference in serum adiponictin levels of 3.82 μg/ml (p = 0.025) is observed comparing patients in which SQI-improved to patients that SQI-declined during the study period. The difference is mostly due to a decrease in serum adiponectin levels in patients that decline in SQI (−3.20 μg/ml). Conclusion Improvements in sleep quality were associated with higher serum adiponectin-levels, and improved measures of glycemic metabolism which may have beneficial effects on metabolic syndrome and cardiovascular health. Clinical trial registration name and number The Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study is registered at https://clinicaltrials.gov/ct2/show/NCT01086800 .

Digital therapeutics, treatments delivered remotely and enabled by modern technology, facilitate the provision of personalized, evidence-based, interdisciplinary interventions to manage the complexities associated with Parkinson’s disease. In the context of the COVID-19 pandemic, the need for digital therapeutics has arguably never been greater. However, despite new advances in technology and a heightened interest due to the pandemic, digital therapeutics remain underdeveloped and underutilized. In this paper, we briefly review practical applications and emerging advances in digital therapeutic platforms that target motor and non-motor signs and healthy lifestyle behaviors such as regular exercise, a healthful diet and optimal sleep hygiene habits. Future applications which could transform personalized self-management and patient care are presented. Opportunities, drawbacks and barriers to access are discussed.

Background The intervention in the Lifestyle Medicine Clinic from La Carlota Hospital gives an opportunity to assess the clinical effect of a healthy lifestyle in an inpatient setting with emphasis in a plant-based diet, supervised daily exercise, sleep hygiene, psychological and optional spiritual therapies. This work evaluated the effect of short-term therapy on biometrics and blood profiles' risk factors for non-communicable diseases (NCDs). Methods Twenty-five patients were enrolled in the intervention, 12 for the 10-day intervention and 13 for the 21-day intervention. Results The intervention improved most of the NCDs risk factors for the 10-day intervention weight decreased by -4.3% (p < .001), BMI -4.1% (p < .001), SBP -16.3% (p = .002), DBP -11.8% (p = .004), fasting glucose -31.3% (p = .041), total cholesterol -12.8% (p < .001), LDL -13.9 (p = .017), triglycerides and HDL lack statistical significance, however, there was a reduction of -7.7% and -9% respectively. For the 21-day intervention weight decreased by -8.3% (p = .016), SBP -11.2% (p = .005), DBP -11.4% (p = .022), triglycerides -39.5% (p = .034), total cholesterol -23.6% (p < .000), HDL -14.7% (p = .038), LDL -27.3% p < .000), BMI and fasting glucose presented a -15.2% and -21.2% reduction respectively without statistical significance. Conclusion The present study confirms that short-term lifestyle interventions effectively reduce the risk factors associated with NCD's.

ObjectivePoor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults.MethodsWe conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50–80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO).ResultsIntention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = −1.27, 95% confidence interval (CI) −1.61 to −0.89; SHEEP: d = −0.69, 95% CI −0.96 to −0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = −1.19; SHEEP: d = −1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = −0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = −0.25; SHEEP: d = −0.09), and WASOPSG (MBTI: d = −0.26; SHEEP (d = −0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects.ConclusionsMBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

The COVID-19 pandemic has introduced uncertainties that have disrupted regular routines. Sleep may be adversely affected by stressful circumstances that jeopardize general health. Hence, the impact of home confinement on the sleep efficiency of the general population was assessed. An online survey was conducted by using the Pittsburgh sleep quality index (PSQI) to assess sleep duration, sleep efficiency, latency to fall asleep, and global PSQI score. Questions pertaining to demography, home confinement, and anxiety were included. Data was collected from the residents of the Southwestern region from April 15, 2020 to May 15, 2020. Data were analyzed through bivariate, multivariate logistic regression, and independent t tests. A total of 593 subjects responded to the survey. Males (OR 1.92 [1.3–2.7], p

Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. Methods A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis. Results Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. Conclusions General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice.

Introduction The purpose of this quality improvement project was to improve health-care provider consistency in addressing and documenting the use of sleep hygiene in children with neurodevelopmental disorders in alignment with evidence-based strategies. Method The project took place over 12 weeks and used a parent-completed screening tool and SmartPhrase technology incorporated into the patient note and discharge summary. A preimplementation and postimplementation query of the electronic medical record was used to determine change effectiveness. Results The postimplementation query found a 42% increase in documentation of sleep hygiene. In addition, a 55% increase in documentation of sleep hygiene with the initiation of melatonin was noted. Discussion The increase in documentation supports success of this initial practice change and demonstrates adherence to evidence-based sleep hygiene strategies. The project provided evidence of a significant improvement in electronic medical record documentation, highlighting an increased awareness of sleep issues in children with neurodevelopmental disorders.

Background: Insomnia disorder is a public health concern and is often considered a normal aging phenomenon. Aim of the study: evaluating the effect of sleeping instruction on reducing insomnia among the elderly. Design: A quasi-experimental design. Settings: conducted at sleep disturbance outpatient clinic in Aswan university hospital g a structured interview questionnaire & Athens insomnia scale Results: The designed sleep hygiene program had statistically significant improvement in elderly knowledge and practices. Indeed, there was no statistically significant correlation between elderly’ sleep hygiene and Athens insomnia scale as sleep latency, sleep duration, sleep efficiency, sleep disturbances, and day time dysfunction at the pre and post-intervention phases at P < 0.05.Conclusion: The designed sleep hygiene program don in this study had statistically significant improvement in elderly knowledge and practices and reducing insomnia. Recommendations: Design an awareness Program regarding insomnia among the elderly to enhance sleep by emphasizing the importance of sleep hygiene practice.

The COVID-19 pandemic has had a negative impact on mental health. Cases of psychosis associated with SARS-CoV-2 infection have been noted. The Women’s Mental Health Program at the University of Arkansas for Medical Sciences determined four-fold increase from data from the last 5 years. We propose that the pandemic should be considered a risk factor for postpartum psychosis. Providers should emphasize sleep hygiene and monitor carefully for psychosis in postpartum women.

Objective:Having good sleep hygiene and knowledge of nursing students is important in terms of their sleep hygiene teaching. This study aims to determine the relationship between the knowledge and practices of sleep hygiene according to the chronotype of nursing students.Materials and Methods:The study was conducted as a cross-sectional questionnaire-based study consisting of 171 nursing students studying at the Health School of a university in the 2019-2020 academic year. The research data were collected using an individual identification form, Sleep Hygiene index and evaluation form to determine morning and evening chronotypes in the human circadian rhythm.Results:When the chronotypes of the students were examined, the circadian rhythm mean score was 61.83±2.43 for the morning type, 51.00±4.71 for the intermediate type and 29.00±0.00 for the evening type. The average Sleep Hygiene index of the students was found to be 16.73±6.68. When the groups were compared, the smoking status of those who were close to the evening type, compared to the morning type and the intermediate type, was found to be statistically significantly higher (p

Introduction Poor sleep is a pervasive problem for hospitalized patients and can contribute to adverse health outcomes. Methods We aimed to improve self-reported sleep for patients on a general medicine ward as measured by the Richards-Campbell Sleep Questionnaire (RCSQ) as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question addressing quietness at night. We utilized a non-pharmacologic sleep hygiene bundle composed of a short script with sleep hygiene prompts, such as whether patients would like the shades closed or the lights turned off, as well as a sleep package including an eye mask, earplugs, lavender scent pad, and non-caffeinated tea. Relaxing music was played at bedtime and signs promoting the importance of quietness at night were placed around the unit. Front-line champions were identified to aid with implementation. Results A total of 931 patients received the intervention. In a sample of surveyed patients, we observed an increase in the RCSQ global score from 6.0 (IQR 3.0-7.0) to 6.2 (IQR 4.0-7.8) from the pre- to post- intervention periods (p = 0.041), as well as increases in three of the five individual survey components. Additionally, HCAHPS "quietness at night" score increased on the unit from 34.1% pre-intervention to 42.5% post-intervention. Conclusion A nonpharmacologic sleep hygiene protocol paired with provider education and use of champions was associated with modest improvements in patients' perceived sleep and unit HCAHPS scores.

Background Ne-Zake is the drinking of alcohol before sleeping for helping to fall asleep and sleep well, and Mukae-Zake is the drinking of alcohol in the morning for “calming down” or “curing hangovers”. Objective We sought to examine the relationship of insomnia with Ne-Zake and Mukae-Zake among healthy middle-aged Japanese farmers. Methods In a cross-sectional study of 746 participants (mean age, 59.5 years; women, 25.9%), Ne-Zake and Mukae-Zake were defined based on a self-administered questionnaire. Insomnia was defined as the Athens Insomnia Scale Japanese version ≥6 or usage of sleeping pills in the previous year. Logistic regression was used to calculate odds ratio (OR) of insomnia related to Ne-Zake and Mukae-Zake adjusting for sex, age, presence of sleep-related disorders, frequency of alcohol consumption, and quantity of alcohol consumed per one occasion. Results We observed insomnia, Ne-Zake, and Mukae-Zake in 174 (23.3%), 140 (18.8%), and 37 (5.0%) participants, respectively. After adjustment for demographic and confounding factors, participants with Ne-Zake had a significantly higher prevalence of insomnia (OR 2.00 [95% confidence interval, 1.27–3.16]), compared to those without Ne-Zake. Mukae-Zake was also independently associated with a higher prevalence of insomnia among men (OR 3.26 [1.55–6.87]). Participants with both Ne-Zake and Mukae-Zake had a highly significant association with insomnia (OR 4.77 [2.01–11.3]) than those with neither Ne-Zake nor Mukae-Zake. Additionally, for insomnia, the association of Mukae-Zake was more pronounced than that of Ne-Zake (OR 4.09, 95% CI 1.14–14.7, p = 0.031; and OR 1.81, 95% CI 1.08–3.06, p = 0.026, respectively). Conclusion Ne-Zake and Mukae-Zake were associated with insomnia independent of the quantity and frequency of alcohol consumption among Japanese farmers. This finding can be used for stratifying individuals with insomnia not only to improve sleep hygiene but also to prevent alcohol dependence by informing the general population that alcohol has a negative effect on sleep, contrary to popular beliefs.

Insomnia is one of the most common health problems. Approximately one-third of adults show symptoms related to insomnia. Around 9%-15% of people have sleeping disorders dan suffer the consequences of it in the daytime, and roughly 6% suffer from diagnosed insomnia. Although the prevalence and significant effects of insomnia have been known, sleep disorders are still rarely diagnosed and receive proper treatments. Lack of sleep will create sleep debt that the body will have to compensate for by adding more sleep time in the next day. Should this compensation fail to be fulfilled, the individual will suffer from excessive sleepiness, memory problems, difficulty concentrating, and disturbances in performing daily activities. Chronic lack of sleep can also decrease memory and cognitive abilities, trigger mood disorders and even cause hallucination. The Sidang Jemaat Allah Bethlehem church (GSJA) is one of the biggest churches in Bogor. The people of GSJA’s knowledge of healthy sleep patterns and their sleep quality was unknown. Therefore, it was necessary to provide sleep health education to raise the awareness of the importance of healthy sleep patterns, both the quantity and the quality, in practicing a healthy lifestyle. We also assessed their sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The data show that out of 41 participants, 30 of them (73.11%) have poor sleep quality (score ≥ 5) and most of them were in the 71-80-year-old age group. The participants' level of understanding about sleep hygiene has increased after the event.

Pediatric-onset multiple sclerosis (POMS), representing approximately 5% of all MS cases, affects the central nervous system during its ongoing development. POMS is most commonly diagnosed during adolescence but can occur in younger children as well. For pediatric patients with MS, it is critical to manage the full impact of the disease and monitor for any effects on school and social functioning. Disease management includes not only disease-modifying therapies but also strategies to optimize wellbeing. We review the interventions with the highest evidence of ability to improve the disease course and quality of life in POMS. High levels of vitamin D and a diet low in saturated fat are associated with lower relapse rates. Exercise ameliorates fatigue and sleep. Behavioral strategies for sleep hygiene and mood regulation can also improve fatigue and perceived health. POMS management should be addressed holistically, including assessing overall symptom burden as well as the psychological and functional impact of the disease.

Robin M Tucker,1 Dawn A Contreras,2 Breanne R Carlson,2 Anita Carter,2 Christopher L Drake3 1Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, 48824, USA; 2Health and Nutrition Institute, Michigan State University Extension, Michigan State University, East Lansing, MI, 48824, USA; 3Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USACorrespondence: Robin M TuckerDepartment of Food Science and Human Nutrition, Michigan State University, 2110 S. Anthony Hall, 474 S. Shaw Ln, East Lansing, MI, 48824, USATel +1-517-353-3408Email tucker98@msu.eduPurpose: Sleep problems pose serious public health concerns, and evidence suggests that the problem is worsening. Both sufficient sleep quantity and quality are needed for optimal health, particularly among older adults, but access to sleep care can be difficult. This study examined the efficacy of a six-week sleep behavior change program designed for older adults that was delivered virtually by health educators.Participants and Methods: This quasi-experimental pilot study (intervention n = 22; control n = 31) explored the effects of the Sleep Education for Elders Program (SLEEP) on sleep outcomes, which included: 1) sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI); 2) sleep duration, extracted from the PSQI; 3) insomnia symptoms, measured by the Insomnia Severity Index; 4) sleep hygiene behaviors, obtained from the Sleep Hygiene Index; and 5) excessive daytime sleepiness, measured by the Epworth Sleepiness Scale.Results: After SLEEP, the intervention group experienced significantly improved sleep quality (p < 0.001), a reduction in maladaptive sleep hygiene behaviors (p = 0.007), and reduced daytime sleepiness (p < 0.027) compared to the control group. Effect sizes for all five sleep measures were medium or large. In the intervention group, all changes were judged to be clinically meaningful (≥ 0.5 SD) except for improvements in daytime sleepiness.Conclusion: These data support the efficacy of a group-based, virtual behavior change intervention in improving sleep outcomes among older adults.Keywords: insomnia, sleep hygiene, adult, public health, multidimensional sleep health

Our sleep-wake cycle is determined by the interaction between our homeostatic sleep drive and circadian rhythm. Each of us has a personalised biological rhythm or chronotype that determines the optimal time to fall asleep and wake up. Chronic sleep deprivation has been linked to the development of several physical and mental health disorders, as well as accidents and occupational errors. Around the world, growing recognition of the importance of sleep has led to the adoption of practices that promote sleep health. Given that Singaporeans were consistently found to be one of the most sleep-deprived populations in the world, we believe that there is an urgent need to pursue the introduction of community-based sleep health interventions here. This includes sleep education and promotion of sleep hygiene, adopting practices to reduce social jetlag and improve sleep health, and enhancing screening and treatment of sleep disorders.

Background Sleep is essential for mental health at all ages, but few studies have investigated the importance of sleep for mental health in early childhood. Therefore, this study examined the association between mental health and sleep habits/problems in children aged 3–4 years. Methods Children aged 3 to 4 years who were living in the community (n = 415; 211/204 boys/girls) were recruited for this study. Their mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and their sleep habits/problems were evaluated using the Child and Adolescent Sleep Checklist. Results Based on the total difficulties score of the SDQ, the children were divided into two groups: a poor mental health group (n = 76) and a control group (n = 339). In terms of sleep habits, which included total sleep time, bedtime, wake time, and nap conditions, there were no differences between the two groups. Regarding sleep-related problems, however, anxiety before going to sleep (p = 0.026), circadian rhythm abnormalities (p = 0.014), and sleepiness during classes outside of naptimes (p = 0.031) were significantly higher in the poor mental health group than in the control group. Multiple regression analysis showed that poor mental health status was significantly associated with sleepiness and snoring (p = 0.017 and p = 0.018, respectively). Conclusions The mental health status of 3–4-year-old children was associated with sleep-related problems, namely sleepiness and snoring. Healthcare providers should pay attention to children’s irregular sleep-wake patterns; moreover, interventions for appropriate sleep hygiene will reduce the psychological burden on both children and their families.

Restless leg syndrome (RLS) is a sensory-motor problem characterized by an uncomfortable and unpleasant feeling that causes a strong and irresistible desire to move the legs, often during periods of inactivity during sleep. Published full-text studies including non-pharmacological interventions used in the management of restless leg syndrome constitute the data of the study. Data were collected from MEDLINE-Pubmed, Science Direct, CINAHL electronic databases. As a result of the search, a total of 10,453 articles were reached. The study sample included quasi-experimental, experimental, or randomized controlled trials, which were published in English, with non-pharmacological interventions used to cope with restless leg syndrome, with full text available without any year limitation. Therefore, the sample consisted of 25 research articles. Non-pharmacological interventions discussed in this study are acupuncture, cognitive behavioral therapy, yoga, exercise, sleep hygiene training, near-infrared light therapy, vibration, and massage techniques. In our systematic review, it was found that non-pharmacological methods used to cope with RLS reduce RLS symptoms, RLS severity and mental health problems (depression, anxiety, stress, etc.), and increase quality of life and sleep quality. However, most of the studies we have reviewed are not randomized controlled studies and the sample group of most of them is small. Therefore, their results do not constitute sufficient evidence. In our study, it was recommended to conduct randomized controlled studies with large samples to cope with RLS.

Background Cognitive behavioral therapy for insomnia (CBT-I) has moderate-to-large effects on insomnia among young adult drinkers, with preliminary data indicating that improvements in insomnia may have downstream effects on alcohol-related consequences. However, the mechanism(s) by which insomnia treatment may facilitate reductions in alcohol-related problems is unclear. Secondary outcome data from a randomized pilot trial were used to examine CBT-I effects on four proposed mediators of the insomnia/alcohol link: alcohol craving, delay discounting, negative affect, and difficulties with emotion regulation. Methods Young adults (ages 18 to 30 years) with insomnia who reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomized to receive CBT-I (n = 28) or to a sleep hygiene control (n = 28). Outcomes were assessed at baseline, after 5 weeks of treatment, and at 1-month posttreatment. Results Relative to those in sleep hygiene, CBT-I participants reported greater decreases in alcohol craving (d = 0.33) at the end of treatment and greater 1-month posttreatment decreases in delay discounting of large rewards (d = 0.42). CBT-I did not have a significant effect on delay discounting of smaller rewards or momentary negative affect. There was also no significant treatment effect on difficulties with emotion regulation, although findings were confounded by a significant group difference at baseline in difficulties with emotion regulation. Conclusions Treatment of insomnia may lead to improvements in alcohol craving and delay discounting of large rewards among young adult drinkers with insomnia. Additional research examining whether improvement in insomnia is a mechanism for improvement in addiction domains is warranted.

This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Observational studies demonstrate that subjectively assessed short sleep increases hypertension risk, though conflicting results are observed in studies of objectively assessed short sleep. Intervention studies demonstrate that mild and severe sleep restriction are associated with higher BP. Rotating and night shift work are associated with hypertension as shift work may exacerbate the detrimental impact of short sleep on BP. Further, studies demonstrate that shift work may increase nighttime BP and reduce BP control in patients with hypertension. Finally, moderate to severe obstructive sleep apnea is associated with hypertension, particularly resistant hypertension. Obstructive sleep apnea is also associated with abnormal 24-hour ambulatory BP profiles, including higher daytime and nighttime BP, nondipping BP, and a higher morning surge. Continuous positive airway pressure treatment may lower BP and improve BP dipping. In conclusion, efforts should be made to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.

Symptoms of psychological distress and disorder have been widely reported in people under quarantine during the COVID-19 pandemic;in addition to severe disruption of peoples’ daily activity and sleep patterns This study investigates the association between physical-activity levels and sleep patterns in quarantined individuals An international Google online survey was launched in April 6th, 2020 for 12-weeks Forty-one research organizations from Europe, North-Africa, Western-Asia, and the Americas promoted the survey through their networks to the general society, which was made available in 14 languages The survey was presented in a differential format with questions related to responses “before” and “during” the confinement period Participants responded to the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the short form of the International Physical Activity Questionnaire 5056 replies (59 4% female), from Europe (46 4%), Western-Asia (25 4%), America (14 8%) and North-Africa (13 3%) were analysed The COVID-19 home confinement led to impaired sleep quality, as evidenced by the increase in the global PSQI score (4 37 ± 2 71 before home confinement vs 5 32 ± 3 23 during home confinement) (p