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Objective: This systematic review and meta-analysis evaluates the efficacy in improving sleep quality and safety of hypnotics in individuals aged 65 years or older compared to those under 65 years., Methods: MEDLINE, EMBASE, Web of Science, and EBM Reviews were searched for randomized clinical trials comparing hypnotics to the placebo in adults with chronic insomnia between Jan 2000 and Dec 2022. The efficacy outcome included all participant self-assessments sleep quality questionnaires. The safety outcome included acceptability and tolerance. Standardized mean differences (SMD) was estimated using a random effect model., Results: We included 17 and 53 clinical trials with 3688 and 14,720 participants in the ≥65 years and <65 years group respectively. The SMD for the sleep quality outcome was -0.36 [Confidence interval (CI) 95 %: 0.45;-0.26] in the ≥65 years group compared to -0.51 [95%CI: 0.61; -0.41] in the <65 years group (p = 0.02). Differences in efficacy were observed between pharmacological classes. The overall SMD for the tolerance outcome was - 0.25 [95%CI: 0.34; -0.16] favoring the placebo group (p < 0.001). In the ≥65 years group the SMD was -0.07 [95%CI: 0.21; 0.08] compared to -0.31 [95%CI: 0.41; -0.21] in the <65 years group (p = 0.01). There were no differences for acceptability., Conclusion: We found that some hypnotics classes could be less effective in older individuals. We encourage authors to include details on multimorbidity and polypharmacy in their publications., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Thien Thanh Dang-Vu reports a relationship with Eisai Inc that includes: consulting or advisory. Thien Thanh Dang-Vu reports a relationship with Idorsia Pharmaceuticals Ltd that includes: consulting or advisory. Thien Thanh Dang-Vu reports a relationship with Paladin Labs Inc that includes: funding grants. Thien Thanh Dang-Vu reports a relationship with Jazz Pharmaceuticals Inc that includes: funding grants. Philippe Desmarais reports a relationship with Eisai Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: National estimates and trends in insomnia symptoms in Canada are outdated. Updates are needed to inform the development of targeted prevention and intervention strategies. This study aimed to examine the prevalence and trends in nighttime insomnia symptoms among Canadians aged 12 years and older between 2007 and 2021., Methods: The Canadian Community Health Survey (CCHS), a nationally representative, repeated cross-sectional survey was used. Nighttime insomnia symptoms were self-reported and defined as trouble going to sleep or staying asleep most or all of the time., Results: This study included data from 197,469 participants. Nighttime insomnia symptoms in Canadians have remained relatively stable from 2007 to 2021, with higher prevalence in adults (18-20 %), particularly women (19-24 %), and those with a medium level of education defined as secondary school graduation (16-21 %). However, nighttime insomnia symptoms became 1.24-fold more prevalent from 2007 to 2021 among women aged 18-64 years (19.3 % vs. 24.0 %) and 1.33-fold more prevalent among those with a medium level of education (15.9 % vs. 21.2 %). Nighttime insomnia symptoms were roughly two times more prevalent in individuals with poorer self-perceived general health, mental health, and life satisfaction compared to those with better self-perception. The prevalence of nighttime insomnia symptoms among those with poor general health increased 1.18-fold from 23.8 % in 2007 to 28.1 % in 2021., Conclusions: Over this 14-year period, nighttime insomnia symptoms have remained consistently high in Canada, but have increasingly affected certain subgroups. Targeted efforts are needed to address this issue in the most affected segments of the population., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Charles M. Morin has received research grants from Eisai, Idorsia, and Lallemand Health; has served on advisory boards for Idorsia and Haleon; and received royalties from Mapi Research Trust. Thien Thanh Dang-Vu has received research grants from Jazz Pharmaceuticals and Paladin Labs, and has served on advisory boards for Eisai and Idorsia. Judith R. Davidson has advised, and owns shares in, HALEO. The other authors have declared no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The lack of current Canadian practice guidelines for the management of insomnia poses a challenge for healthcare providers (HCP) in selecting the appropriate treatment options. This study aimed to establish expert consensus recommendations for the management of chronic insomnia in Canada., Composition of the Committee: Sixteen multidisciplinary experts in sleep medicine and insomnia across Canada developed consensus recommendations based on their knowledge of the literature and their practical experience., Methods: The consensus recommendations were developed through a Delphi method. Consensus was reached if at least 75 % of the voting participants "agreed" or "strongly agreed" with the corresponding statements. The quality of supporting evidence was rated using a GRADE rating system., Report: Among 37 recommendations that reached consensus for the management of chronic insomnia, the experts recommend and agree that., Conclusion: These consensus recommendations highlight the need to increase awareness, capacity for, and access to CBT-I; integrate newly approved pharmacotherapy; reduce both self-medication and medications with limited evidence or low risk/benefit ratio., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alex Desautels reports operating grants: CHIR, AASM, FRQ-S, HSF; research contracts: Eisai and Takeda; advisory boards: Eisai, Paladin Labs and UCB; speaking engagements: Eisai, Jazz Pharma and Paladin Labs. Jeffrey Habert reports Advisory Board/Speaker: Boehringer, Eli- Lilly, Elvium, Takeda, Bausch, Astra-Zeneca, Novartis, Lundbeck, Novo-Nordisk, Janssen, Eisai, HLS, Otsuka, Idorsia Pfizer, Amgen, Abbvie, GSK, Bayer, Valeo; Scientific Committees/Speaker: MDBriefcase, Liv, MedPlan, Master Clinician Alliance, Academy, Bridge, PeerVoice, Seacourses, Thrombosis Canada, Meducom, CHRC, CPD Network, CTC, STA, CCRN, Telus Health, EOCI, AgenceUnik, Humber Hospital, ABPHE, CSEM. Atul Kular reports serving on advisory board/speaker for Elvium, Bausch, Lundbeck, Eisai, Otsuka, Idorsia, Abbvie, Jazz; scientific committees/speaker for ICPDHC CPD Network, CCRN, and Telus Health. Serge Lessard reports Advisory Board/Speaker: AbbVie, Biron, Bausch, Eisai, Elvium, Idorsia, Jazz, Takeda, Lundbeck, Janssen, Otsuka, Sunovi; Scientific Committees/Speaker: MD Briefcase, Liv, MedPlan, CCRN; research grants from: Allergan, Janssen. Michael S.B. Mak reports education grants, consulting and speaking fees with Eisai Inc; education grants and speaking fees with Paladin; education grants, consulting and speaking fees with Jazz Pharmaceuticals; education grants and stocks with ResMed; consulting and speaking fees with Idorsia. Charles M. Morin reports funding from the Canadian Institutes of Health Research, Fonds de recherche du Quebec, National Institutes of Health; consulting for Eisai, Idorsia, Haleon; royalties from Mapi Research Trust., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: To estimate the prevalence of insomnia and the use of sleep aids among Canadian adults., Methods: Data were derived from a phone interview conducted (April to October 2023) with a stratified, population-based sample of 4037 adults (57.6 % females; mean age 50.6 ± 18.4; range 18-102 years old) living in Canada. Post-stratified survey weights were included in the analysis to ensure the representativity of the adult Canadian population., Results: The prevalence estimate of insomnia disorder was 16.3 % (95 % CI 15.1-17.6), with higher rates in females (risk ratio [RR] 1.24, 95 % CI 1.06-1.45), Indigenous peoples (RR 1.77, 95 % CI 1.27-2.47), and individuals with poorer mental or physical health. Overall, 14.7 % of respondents reported having used prescribed sleep medications in the previous 12 months, 28.7 % used natural products or over-the-counter (OTC) sleep aids, 15.6 % used cannabis-derived products and 9.7 % used alcohol for sleep in the last 12 months. Higher proportions of females used prescribed medication (RR 1.79, 95 % CI 1.31-2.43) and natural products or OTC medication (RR 1.41, 95 % CI 1.16-1.71), while more males used cannabis (RR 1.33, 95 % CI 1.03-1.72) and alcohol (RR 1.67, 95 % CI 1.16-2.33) for sleep. Higher proportions of older adults (≥65 years) were taking prescribed medications, while more young adults (18-35 years) used natural products or OTC medications, cannabis, and alcohol as sleep aids., Conclusions: Insomnia is a highly prevalent condition in Canada and there is widespread and increasing use of various medications and substances to cope with this health issue. These findings highlight the need for public health interventions to promote healthy sleep and for wider dissemination of evidence-based treatments for insomnia, such as cognitive behavioral therapy which is the first-line treatment for insomnia in practice guidelines, to reduce sleep health disparities., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Charles M. Morin reports financial support was provided by Canadian Institutes of Health Research. Charles M. Morin reports a relationship with Canadian Institutes of Health Research that includes: funding grants. Charles M. Morin reports a relationship with National Institutes of Health that includes: funding grants. Charles M. Morin reports a relationship with Eisai Inc that includes: funding grants. Charles M. Morin reports a relationship with Idorsia Pharmaceuticals Ltd that includes: funding grants. Charles M. Morin reports a relationship with Lallemand Health Solution that includes: funding grants. Charles M. Morin reports a relationship with Haleon that includes:. Thien Thanh Dang-Vu reports a relationship with Canadian Institutes of Health Research that includes: funding grants. Thien Thanh Dang-Vu reports a relationship with Natural Sciences and Engineering Research Council of Canada that includes: funding grants. Thien Thanh Dang-Vu reports a relationship with Weston Family Foundation that includes: funding grants. Thien Thanh Dang-Vu reports a relationship with Hypersomnia Foundation that includes: board membership and funding grants. Thien Thanh Dang-Vu reports a relationship with Jazz Pharmaceuticals that includes: consulting or advisory, funding grants, and speaking and lecture fees. Thien Thanh Dang-Vu reports a relationship with Paladin Labs Inc that includes: funding grants. Thien Thanh Dang-Vu reports a relationship with Eisai Inc that includes: board membership, consulting or advisory, and speaking and lecture fees. Thien Thanh Dang-Vu reports a relationship with Idorsia Pharmaceuticals Ltd that includes: board membership and consulting or advisory. Rebecca Robillard reports a relationship with Canadian Institutes of Health Research that includes: funding grants. Rebecca Robillard reports a relationship with Veterans Affairs Canada that includes: funding grants. Rebecca Robillard reports a relationship with Boehringer Ingelheim Canada Ltd that includes: speaking and lecture fees. Rebecca Robillard reports a relationship with Canadian Sleep Research Consortium that includes: board membership. Rebecca Robillard reports a relationship with Canadian Sleep Society that includes: board membership. Charles M. Morin has patent with royalties paid to Mapi Research Trust. Co-author reports payment from Wellcome Foundation - Rebecca Robillard. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Insomnia is more common as people age. Several common hypnotics used to treat insomnia often do not adequately alleviate sleep issues in older adults and may be associated with negative residual effects such as an increased risk of falls, cognitive impairment, automobile accidents, and lack of response to auditory stimuli. The objective of these analyses of three clinical studies was to investigate the efficacy and safety of the dual orexin-receptor antagonist lemborexant (LEM) in older adults., Methods: Study E2006-G000-304 (Study 304; NCT02783729) was a randomized, double-blind, placebo (PBO)-controlled, active-comparator trial where subjects with insomnia disorder received LEM 5 mg (LEM5), LEM 10 mg (LEM10), zolpidem tartrate extended-release 6.25 mg (ZOL), or PBO for 30 days. In crossover Study E2006-E044-106 (Study 106; NCT02583451), healthy subjects (good sleepers) received LEM 2.5 mg, LEM5, LEM10, or PBO for eight nights or zopiclone on days 1 and 8 (and PBO on days 2-7). In crossover Study E2006-A001-108 (Study 108; NCT03008447), healthy subjects received a single dose of LEM5, LEM10, PBO, or ZOL. Sleep assessments included polysomnography-based latency to persistent sleep (LPS), wake after sleep onset (WASO), WASO in the second half of the night (WASO2H), sleep efficiency, postural stability, middle-of-the-night and next-day cognitive performance, middle-of-the-night auditory awakening threshold and return-to-sleep latency, and driving performance., Results: Overall, 453 of 1006 (45%; Study 304), 24 of 48 (50%; Study 106), and 28 of 56 (50%; Study 108) subjects were aged ≥ 65 years. In Study 304, LEM decreased (improved) LPS, WASO, and WASO2H from baseline more than ZOL and PBO; subjects treated with LEM had greater increases in sleep efficiency (improved) than with ZOL or PBO. In both Studies 304 and 108, postural stability was not impaired at waketime in subjects who received LEM compared with PBO. At waketime, LEM did not impair memory compared with PBO. In Study 108, following middle-of-the-night awakening, LEM and ZOL did not affect subjects' ability to awaken to auditory stimuli; LEM did not affect tests of memory and attention. In Study 106, LEM did not impair next-day driving performance in healthy elderly compared with PBO. LEM was well tolerated in subjects aged ≥ 65 years., Conclusions: LEM provided benefits on sleep variables without next-morning residual effects in subjects aged ≥ 65 years, supporting LEM as a treatment option for older adults with insomnia., Trial Registration Numbers and Dates of Registration: Study 304: ClinicalTrials.gov identifier, NCT02783729, date of registration, 26 May 2016. Study 106: ClinicalTrials.gov identifier, NCT02583451, date of registration, 22 October 2015. Study 108: ClinicalTrials.gov identifier, NCT03008447, date of registration, 2 January 2017., (© 2024. The Author(s).)

Objective: This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework., Methods: 177 participants (86.3 % female; M age  = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up., Results: Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses., Conclusion: Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Josee Savard reports financial support was provided by Astellas. Thien Thanh Dang-Vu reports financial support was provided by Eisai,Idorsia,Jazz Pharmaceuticals, andPaladin Labs. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Insomnia treatment among individuals with comorbid insomnia and obstructive sleep apnea is suboptimal. In a pilot randomized controlled trial, 19 individuals with comorbid insomnia and obstructive sleep apnea were allocated to one of two arms: EX + EX, consisting of two 8-week phases of exercise training (EX), or RE + CBTiEX, encompassing 8 weeks of relaxation training (RE) followed by 8 weeks of combined cognitive-behavioral therapy and exercise (CBTiEX). Outcomes included Insomnia Severity Index (ISI), polysomnography, and cardiorespiratory fitness measures. A mixed-model analysis of variance revealed a Group × Time interaction on peak oxygen consumption change, F(1, 14) = 10.1, p = .007, and EX increased peak oxygen consumption (p = .03, g' = -0.41) and reduced ISI (p = .001, g' = 0.82) compared with RE (p = .49, g = 0.16) post-8 weeks. Post-16 weeks, there was a significant Group × Time interaction (p = .014) driven by RE + CBTiEX yielding a larger improvement in ISI (p = .023, g' = 1.48) than EX + EX (p = .88, g' < 0.1). Objective sleep was unchanged. This study showed promising effects of regular EX alone and combined with cognitive-behavioral therapy for insomnia on ISI in comorbid insomnia and obstructive sleep apnea.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements., Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test., Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05)., Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Study Objective: To provide a comprehensive assessment of sleep state misperception in insomnia disorder (INS) and good sleepers (GS) by comparing recordings performed for one night in-lab (PSG and night review) and during several nights at-home (actigraphy and sleep diaries)., Methods: Fifty-seven INS and 29 GS wore an actigraphy device and filled a sleep diary for two weeks at-home. They subsequently completed a PSG recording and filled a night review in-lab. Sleep perception index (subjective/objective × 100) of sleep onset latency (SOL), sleep duration (TST) and wake duration (TST) were computed and compared between methods and groups., Results: GS displayed a tendency to overestimate TST and WASO but correctly perceived SOL. The degree of misperception was similar across methods within the GS group. In contrast, INS underestimated their TST and overestimated their SOL both in-lab and at-home, yet the severity of misperception of SOL was larger at-home than in-lab. Finally, INS overestimated WASO only in-lab while correctly perceiving it at-home. While only the degree of TST misperception was stable across methods in INS, misperception of SOL and WASO were dependent on the method used., Conclusions: We found that GS and INS exhibit opposite patterns and severity of sleep misperception. While the degree of misperception in GS was similar across methods, only sleep duration misperception was reliably detected by both in-lab and at-home methods in INS. Our results highlight that, when assessing sleep misperception in insomnia disorder, the environment and method of data collection should be carefully considered., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Thien Thanh Dang-Vu reports financial support was provided by Canadian Institutes of Health Research. Jean-Philippe Gouin reports financial support was provided by Canadian Institutes of Health Research. Thien Thanh Dang-Vu reports a relationship with Eisai Co Ltd that includes: consulting or advisory and speaking and lecture fees. Thien Thanh Dang-Vu reports a relationship with Jazz Pharmaceuticals Inc that includes: consulting or advisory and speaking and lecture fees. Thien Thanh Dang Vu reports a relationship with Paladin Labs Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To identify sociodemographic, psychological, and health factors related to trajectories of insomnia symptoms in older adults during the COVID-19 pandemic., Methods: From May 2020 to May 2021, 644 older adults (mean age = 78.73, SD = 5.60) completed telephone-administered self-reported measures (ie, Insomnia Severity Index, consensus sleep diaries, UCLA Loneliness Scale, Kessler Psychological Distress Scale, Post-Traumatic Checklist, perceived health threat, and International Physical Activity Questionnaire) and provided sociodemographic data at 4 timepoints. Using the Insomnia Severity Index score at each timepoint, group-based trajectory modeling was conducted to identify groups with distinct insomnia trajectories., Results: On average, there was no significant change in insomnia symptoms over time. Three groups with distinct sleep trajectories were identified: clinical (11.8%), subthreshold (25.3%), and good sleepers (62.9%). Older adults who were younger, male, had elevated psychological distress and posttraumatic stress disorder symptoms, perceived more SARS-CoV-2 health threat, spent more time in bed, and had shorter sleep duration during the first wave of the pandemic were more likely to belong to the clinical than to the good sleepers group. Those who were younger, female, had elevated psychological distress and PTSD symptoms, greater loneliness, spent more time in bed, and had reduced sleep duration during the first wave were more likely to belong to the subthreshold than to the good sleepers group., Conclusions: Over 1 in 3 older adults experienced persistent subthreshold or clinically significant insomnia symptoms. Both sleep-related behaviors as well as general and COVID-19-related psychological factors were associated with insomnia trajectories., (Copyright © 2023 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To estimate health care and productivity costs associated with insomnia symptoms in Canadian adults., Methods: Three pieces of information were needed to calculate estimates based on a prevalence-based approach: (1) the pooled relative risk estimates of health outcomes consistently associated with insomnia symptoms obtained from recent meta-analyses of prospective cohort studies; (2) the direct (health care) and indirect (lost productivity due to premature mortality) costs of these health outcomes using the Economic Burden of Illness in Canada information; and (3) the prevalence of insomnia symptoms in Canadian men (18.1%) and women (29.5%) obtained from a nationally-representative survey., Results: The direct, indirect, and total costs of insomnia symptoms in Canada in 2021 were $1.9 billion, $12.6 million, and $1.9 billion, respectively. This value represents 1.9% of the overall burden of illness costs for 2021 in Canada. The 2 most expensive chronic diseases attributable to insomnia symptoms were type 2 diabetes ($754 million) and depression ($706 million). The main contributor to the costs for type 2 diabetes and depression was prescription drugs. A 5% decrease in insomnia symptoms (from 23.8% to 18.8%) would result in an estimated $353 million in avoided costs while a 5% increase in insomnia symptoms (from 23.8% to 28.8%) would result in an estimated $333 million in additional expenditures yearly., Conclusions: Insomnia symptoms greatly contribute to the economic burden of illness in Canada. Reducing the prevalence of insomnia symptoms would reduce its societal burden., (Copyright © 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Study Objectives: To examine the longitudinal association between probable insomnia status and both subjective and objective memory decline in middle-aged and older adults., Methods: 26 363 participants, ≥45 years, completed baseline and follow-up (3 years after baseline) self-reported evaluations of sleep and memory, and neuropsychological testing in the following cognitive domains: memory, executive functions, and psychomotor speed. Participants were categorized as having probable insomnia disorder (PID), insomnia symptoms only (ISO), or no insomnia symptoms (NIS), based on sleep questionnaires. Participants were further grouped based on their sleep change over time. Prospective odds of self-reported memory worsening were assessed using logistic regression, and associations between insomnia and cognitive performance were assessed via linear mixed-effects modeling, adjusted for demographic, lifestyle, and medical factors., Results: An increased odds (OR 1.70; 95% CI 1.29-2.26) of self-reported memory worsening was observed for NIS participants at baseline who developed PID at follow-up compared to those who developed ISO or remained NIS. Additionally, participants whose sleep worsened from baseline to follow-up (i.e. transitioned from NIS to ISO, ISO to PID, or NIS to PID) displayed increased odds (OR 1.22; 95% CI 1.10-1.34) of subjective memory worsening at follow-up compared to those who remained insomnia-free or improved their sleep. There were no significant associations between the development of PID or worsening sleep and performance on neuropsychological tests., Conclusions: These findings of an increased odds for subjective memory decline in middle-aged and older adults with insomnia disorder suggest insomnia may be an important target for early interventions addressing age-related cognitive decline., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The discrepancies in the effects of napping on sleep quality may be due to differences in methodologies, napping behaviours, and daytime activity levels across studies. We determined whether napping behaviours and daytime activity levels are associated with night-time sleep fragmentation and sleep quality in young adults. A total of 62 healthy adults (mean [SD] age 23.5 [4.2] years) completed screening questionnaires for sleep habits, physical activity, medical and psychological history. Actigraphy was used to record sleep including naps. The fragmentation algorithm (K RA ) was applied to the actigraphic data to measure night-time sleep fragmentation. We classified participants' nap frequency as "non-nappers" (0 naps/8 days), "moderate nappers" (1-2 naps/8 days) or "frequent nappers" (≥3 naps/8 days) naps. Nap duration was defined as "short" (≤60 min) or "long" (>60 min). Naps' proximity to the night sleep episode was defined as "early" (≥7 h) and "late" (<7 h) naps. Outcome variables were night-time K RA and actigraphic sleep variables. Frequent nappers had a significantly higher K RA than moderate nappers (p < 0.01) and non-nappers (p < 0.02). Late naps were associated with poorer measures of night sleep quality versus early naps (all p ≤ 0.02). Nap duration and daytime activity were not associated with significant differences in the outcome variables (all p > 0.05). K RA correlated with sleep duration, sleep efficiency, and awakenings (r = -0.32, -0.32, and 0.53, respectively; all p < 0.05). Frequent napping and late naps may be associated with increased sleep fragmentation and poorer sleep quality, reflected in longer sleep onsets and increased awakenings. These findings have implications for public health sleep hygiene recommendations., (© 2022 European Sleep Research Society.)

Study Objectives: To assess the effects of Cognitive Behavioral Therapy for insomnia (CBTi) on subjective and objective measures of sleep, sleep-state misperception and cognitive performance., Methods: We performed a randomized-controlled trial with a treatment group and a wait-list control group to assess changes in insomnia symptoms after CBTi (8 weekly group sessions/3 months) in 62 participants with chronic insomnia. To this end, we conducted a multimodal investigation of sleep and cognition including subjective measures of sleep difficulties (Insomnia Severity Index [ISI]; sleep diaries) and cognitive functioning (Sahlgrenska Academy Self-reported Cognitive Impairment Questionnaire), objective assessments of sleep (polysomnography recording), cognition (attention and working memory tasks), and sleep-state misperception measures, collected at baseline and at 3-months post-randomization. We also assessed ISI one year after CBTi. Our main analysis investigated changes in sleep and cognition after 3 months (treatment versus wait-list)., Results: While insomnia severity decreased and self-reported sleep satisfaction improved after CBTi, we did not find any significant change in objective and subjective sleep measures (e.g., latency, duration). Degree of discrepancy between subjective and objective sleep (i.e., sleep misperception) in sleep latency and sleep duration decreased after CBTi suggesting a better perception of sleep after CBTi. In contrast, both objective and subjective cognitive functioning did not improve after CBTi., Conclusions: We showed that group-CBTi has a beneficial effect on variables pertaining to the subjective perception of sleep, which is a central feature of insomnia. However, we observed no effect of CBTi on measures of cognitive functioning., Competing Interests: Declaration of competing interest The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: XXX, (Copyright © 2022 Elsevier B.V. All rights reserved.)

The pathophysiology of insomnia remains poorly understood, yet emerging cross-disciplinary approaches integrating natural history, observational studies in traditional populations, gene-phenotype expression and experiments are opening up new avenues to investigate the evolutionary origins of sleep disorders, with the potential to inform innovations in treatment. Previous authors have supported that acute insomnia is a normal biopsychosocial response to a perceived or real threat and may thus represent an adaptive response to stress. We further extend this hypothesis by claiming that insomnia reflects a fear-related evolutionary survival mechanism, which becomes persistent in some vulnerable individuals due to failure of the fear extinction function. Possible treatments targeting fear extinction are proposed, such as pharmacotherapy and emotion-based cognitive behavioral therapy., Competing Interests: Conflicts of interest The authors do not have any conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: This study examined the differences in cognitive function between middle-aged and older adults with insomnia disorder, insomnia symptoms only (ISO) or no insomnia symptoms (NIS), in the context of other health and lifestyle factors., Methods: Twenty-eight thousand four hundred eighty-five participants >45 years completed questionnaires, physical examinations, and neuropsychological testing across domains of processing speed, memory, and executive functions. An eight-question instrument assessed participants' sleep, defining subjects with insomnia symptoms, probable insomnia disorder (PID), or NIS. The associations between these three groups and cognitive performance were examined with linear regression models adjusted for lifestyle and clinical factors., Results: PID was identified in 1,068 participants (3.7% of the sample) while 7,813 (27.5%) experienced ISO. Participants with PID exhibited greater proportions of adverse medical and lifestyle features such as anxiety, depression, and diabetes than both other groups. Analyses adjusting for age, sex, education, as well as medical and lifestyle factors demonstrated that adults with PID exhibited declarative memory deficits (Rey Auditory Verbal Learning Test) compared with ISO or NIS. Adults with insomnia symptoms exhibited better performance on a task of mental flexibility than both other groups., Conclusions: These findings suggest that insomnia disorder in middle-aged and older adults is associated with poorer health outcomes and worse memory performance than adults with insomnia symptoms alone or without any sleep complaints, even after adjustment for comorbidities. The assessment of longitudinal data within this cohort will be critical to understand if insomnia disorder may increase the risk of further cognitive decline., (© Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Background: While cognitive-behavioral therapy for insomnia constitutes the first-line treatment for chronic insomnia, only few reports have investigated how sleep architecture relates to response to this treatment. In this pilot study, we aimed to determine whether pre-treatment sleep spindle density predicts treatment response to cognitive-behavioral therapy for insomnia., Methods: Twenty-four participants with chronic primary insomnia participated in a 6-week cognitive-behavioral therapy for insomnia performed in groups of 4-6 participants. Treatment response was assessed using the Pittsburgh Sleep Quality Index and the Insomnia Severity Index measured at pre- and post-treatment, and at 3- and 12-months' follow-up assessments. Secondary outcome measures were extracted from sleep diaries over 7 days and overnight polysomnography, obtained at pre- and post-treatment. Spindle density during stage N2-N3 sleep was extracted from polysomnography at pre-treatment. Hierarchical linear modeling analysis assessed whether sleep spindle density predicted response to cognitive-behavioral therapy., Results: After adjusting for age, sex, and education level, lower spindle density at pre-treatment predicted poorer response over the 12-month follow-up, as reflected by a smaller reduction in Pittsburgh Sleep Quality Index over time. Reduced spindle density also predicted lower improvements in sleep diary sleep efficiency and wake after sleep onset immediately after treatment. There were no significant associations between spindle density and changes in the Insomnia Severity Index or polysomnography variables over time., Conclusion: These preliminary results suggest that inter-individual differences in sleep spindle density in insomnia may represent an endogenous biomarker predicting responsiveness to cognitive-behavioral therapy. Insomnia with altered spindle activity might constitute an insomnia subtype characterized by a neurophysiological vulnerability to sleep disruption associated with impaired responsiveness to cognitive-behavioral therapy., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Study Objectives: Recent studies have suggested that structural abnormalities in insomnia may be linked with alterations in the default-mode network (DMN). This study compared cortical thickness and structural connectivity linked to the DMN in patients with persistent insomnia (PI) and good sleepers (GS)., Methods: The current study used a clinical subsample from the longitudinal community-based Korean Genome and Epidemiology Study (KoGES). Cortical thickness and structural connectivity linked to the DMN in patients with persistent insomnia symptoms (PIS; n = 57) were compared to good sleepers (GS; n = 40). All participants underwent MRI acquisition. Based on literature review, we selected cortical regions corresponding to the DMN. A seed-based structural covariance analysis measured cortical thickness correlation between each seed region of the DMN and other cortical areas. Association of cortical thickness and covariance with sleep quality and neuropsychological assessments were further assessed., Results: Compared to GS, cortical thinning was found in PIS in the anterior cingulate cortex, precentral cortex, and lateral prefrontal cortex. Decreased structural connectivity between anterior and posterior regions of the DMN was observed in the PIS group. Decreased structural covariance within the DMN was associated with higher PSQI scores. Cortical thinning in the lateral frontal lobe was related to poor performance in executive function in PIS., Conclusion: Disrupted structural covariance network in PIS might reflect malfunctioning of antero-posterior disconnection of the DMN during the wake to sleep transition that is commonly found during normal sleep. The observed structural network alteration may further implicate commonly observed sustained sleep difficulties and cognitive impairment in insomnia., (© 2016 Associated Professional Sleep Societies, LLC.)

The development of neuroimaging techniques has made possible the characterization of cerebral function throughout the sleep-wake cycle in normal human subjects. Indeed, human brain activity during sleep is segregated within specific cortical and subcortical areas in relation to the sleep stage, sleep physiological events and previous waking activity. This approach has allowed sleep physiological theories developed from animal data to be confirmed, but has also introduced original concepts about the neurobiological mechanisms of sleep, dreams and memory in humans. In contrast, at present, few neuroimaging studies have been dedicated to human sleep disorders. The available work has brought interesting data that describe some aspects of the pathophysiology and neural consequences of disorders such as insomnia, sleep apnea and narcolepsy. However, the interpretation of many of these results is restricted by limited sample size and spatial/temporal resolution of the employed technique. The use of neuroimaging in sleep medicine is actually restrained by concerns resulting from the technical experimental settings and the characteristics of the diseases. Nevertheless, we predict that future studies, conducted with state of the art techniques on larger numbers of patients, will be able to address these issues and contribute significantly to the understanding of the neural basis of sleep pathologies. This may finally offer the opportunity to use neuroimaging, in addition to the clinical and electrophysiological assessments, as a helpful tool in the diagnosis, classification, treatment and monitoring of sleep disorders in humans.