Actigraphic and Self-reported Sleep in Traffic Accident Victims

Background: Some accident victims report poorer sleep during the months after the trauma, which may double the risk for and is a mediator of the development of a PTSD. Furthermore, subjective and objective sleep measures are often discrepant in PTSD-patients, which is why a ‘sleep state misperception’ of PTSD patients is often hypothesized. Objective: The goal of this study is to assess differences in sleep quality in victims of a traffic accident compared to healthy participants without an accident history as well as differences between objective and subjective sleep quality measures. Methods: We recruited 25 hospitalized accident victims within ten days of an accident and 31 age and sex-matched controls without an accident history. Three months later, participants were given a structured clinical interview (SCID), they completed the Pittsburg Sleep Quality Index (PSQI) for the previous two weeks, wore a wrist actigraph, and kept a sleep log for two consecutive nights. Results: At the three-month follow-up, none of the victims met the criteria for any kind of mental disorder, but scored higher on the Posttraumatic Diagnostic Scale. On the PSQI they reported slightly worse sleep than controls for the previous two weeks, although sleep log and actigraphy measures on the two recording nights showed no group differences. Actigraphy measures showed shorter sleep onset latencies compared to log measures. Conclusions: The accident victims suffered only minimal sleep disturbances three months later. The assumption of a ‘sleep state misperception’ in traffic accident victims is questioned by these results.

How to manage sleep problems

When you get a good night’s rest, you’re better able to tackle the most challenging dementia issues. On the other hand, when your sleep is poor, even small difficulties can cause you to feel frustrated and irritable. And if that’s true for you with a healthy brain, think about how important sleep is for your loved one with dementia. Poor sleep can cause many problems in those with dementia—not to mention often disrupting your own sleep! Although sleep problems are common in dementia, most of them can be managed without medications. Start by using a sleep log. Work to improve your loved one’s sleep habits and modify their daily routines to improve sleep. Be alert for disorders such as sleep apnea and abnormal sleep movements; let your loved one’s doctor know if you suspect them.

Pre-pandemic sleep behavior and adolescents’ stress during Covid-19: a prospective longitudinal study

Objective To prospectively document changes in adolescents’ sleep before versus during the COVID-19 pandemic, and to examine their impact on adolescents’ perceived stress. Methods Sixty-two typically developing adolescents participated in the study before (Time 1: January 15 to March 13, 2020) and during (Time 2: May 15 to June 30, 2020) the COVID-19 pandemic in Canada. At Time 1, each participant’s sleep pattern was assessed in the home environment using actigraphy and sleep logs for seven consecutive nights. Adolescents completed a battery of questionnaires in which they reported on their sleep schedule, duration, and quality, as well as their activities at bedtime, their daytime sleepiness, and their social/emotional behavior. The participants’ parents provided demographic information. At Time 2, each participant completed a sleep log, the same battery of questionnaires regarding sleep, and the Perceived Stress Scale. Results (1) Adolescents’ reported sleep was of longer duration and on a delayed schedule during the COVID-19 pandemic compared to pre-pandemic. (2) A larger proportion of adolescents reported meeting or exceeding the recommended amount of sleep during the COVID-19 pandemic compared to pre-pandemic sleep. (3) “Social jet lag” disappeared during the COVID-19 pandemic. (4) A shorter reported sleep duration and higher level of arousal at bedtime at Time 1 were significant predictors of adolescents’ perceived stress at Time 2—during the COVID-19 pandemic. (5) A higher levels of arousal at bedtime and lower reported sleep quality at Time 2 were concurrently associated with higher levels of perceived stress among adolescents, even when we controlled for the levels of pre-pandemic emotional or behavioral issues, sleep duration, or sleep quality. Conclusion Sleep duration and cognitive-emotional arousal, which are both modifiable behaviors, were associated with adolescents’ perceived stress during the COVID-19 pandemic. These behaviors could be useful targets for preventive interventions aiming to reduce adolescents’ stress in the face of stressogenic situations, such as the COVID-19 pandemic.

Observational Study of the Effect of Moderate and High-Intensity Exercise on Insomnia

The purpose of this observational study is to determine whether moderate-intensity exercises improve the quality of sleep for subjects with insomnia. The duration of this observational study was four weeks. For the first two weeks of the observational study, subjects served as their own control and completed a sleep log. At the beginning of the third week, subjects were randomly split into (1) Group One with moderate-intensity exercise or (2) Group Two with high-intensity exercise. Two-tailed t-tests displayed significant improvements in quality of sleep with the implementation of both moderate and high-intensity exercise. However, Group One participants were found to feel significantly more well-rested than Group Two. The moderate-intensity exercise group showed improvement in quality of sleep, the number of awakenings, and restfulness. In comparison, the high-intensity exercise group demonstrated improvement in the number of awakenings and daytime sleepiness; although, without reported improvement in sleep quality. There were variables in participants’ sleeping environments, including changes in sleep location, travel, sleep-inducing medication, alcohol use, anxiety, unanticipated noise disturbances, and use of electronic devices before bed that was not controlled for in this observational study.

How to manage sleep problems

When you get a good night’s rest, you’re better able to tackle the most challenging dementia issues. On the other hand, when your sleep is poor, even small difficulties can cause you to feel frustrated and irritable. And if that’s true for you with a healthy brain, think about how important sleep is for your loved one with dementia. Poor sleep can cause many problems in those with dementia—not to mention often disrupting your own sleep! Although sleep problems are common in dementia, most of them can be managed without medications. Start by using a sleep log. Work to improve your loved one’s sleep habits and modify their daily routines to improve sleep. Be alert for disorders such as sleep apnea and abnormal sleep movements; let your loved one’s doctor know if you suspect them.

The Influence of Sleep on Glycated Hemoglobin in Pregnancy With Gestational Diabetes

Background: Sleep disturbances have been associated with poor glycemic control in differential clinical settings. Both short and long sleep duration, influence insulin resistance and blood glucose in diabetic patients. Pregnancy is an additional risk for reduced sleep quality and quantity, and the presence of hyperglycemia, as a complicating factor, has being increasingly frequent. Different measures of sleep evaluation, both objectively and subjectively, can provide additional information about the influence of sleep in metabolic control in Gestational Diabetes Mellitus (GDM). Objective: To investigate the influence of sleep quality and objective sleep measures on glycated hemoglobin (HBA1C) in patients with GDM. Methodology: This is a cross-sectional study examining patients with GDM from 2nd to 3rd trimester of pregnancy. Clinical data and behavior questionnaires were collected by a face-to-face interview. Self-Rated Sleep Quality was evaluated by Pittsburgh Sleep Quality Index- (PSQI). In order to improve the accuracy of the information, a 14-day sleep log was obtained, and objective sleep measurements were registered by actigraphic record (5 to 7 days). Results: Overall, GDM patients (N=311), aged from 20 to 46 y (33.1±5.6) were evaluated. Sleep duration ≤6 hours/night was found in 43.4%, and 63.9% reported poor sleep quality (PSQI>5). Sleep duration measured by actigraphy was correlated with sleep duration registered by sleep log (r=.45, p=.04), and with PSQI (r=-.33, p=.002). Sleep quality and sleep duration registered by either actigraphy or sleep log were not correlated with Hba1c. Amongst all, Hba1c varied from 4.3 to 7.0 mg/dL (5.9 ±.53). Sleep fragmentation, measured by the length of time patient spends awake after sleep onset (WASO) was correlated withHba1c level in patients with GDM (r=.41, p=0.04). Conclusion: Sleep duration obtained from the sleep log was a reliable measure correlating with objective sleep parameters registered by actigraphy and with sleep quality. In GDM patients, increased wake time after sleep onset was correlated with higher Hba1c.

Sleep Difference between Adolescents and Young Adults

Background: Sleep is important for maintaining overall physical and mental health. Adolescents and young adults (AYAs) at growing age need more sleep because it acts as the fuel for rapidly growing brain and bodies. Many physicians encounter young people having health issue developed due to improper sleep. Understanding the connection between sleep and health in AYAs is important as the sleep problem is coming up as a global pandemic that can seriously harm the health, safety, productivity of our nation’s young generation, thus, is a major public health concern. Aim: The current study investigates the sleep behavior (such as sleep onset, sleep offset, sleep latency, sleep inertia, actual sleep) of adolescents in comparison to young adults. Methods: Present study is based on self-reported sleep-log entries made by subjects. The collection of data is done on a random basis from school and university set up. Sleep log sheet is an instrument that elicits sleep-related data (sleep onset/offset, latency/inertia, etc.) on a day-to-day basis. Statistical analysis was done using the Mann-Whitney U test at a significance level of p < 0.005. Results: To conduct this study, individuals of two different age groups were selected; adolescent group (age = 14±01 year; n = 564) and young adult (age = 23±01 year; n = 43). The study shows a significant difference between adolescents and young adult’s timings for various sleep variables such as time to bed (p<0.0001), sleep onset (p<0.0001), sleep offset (p<0.0001), sleep inertia (p= 0.0156). Although, no significant difference was reported in actual sleep duration and sleep latency between the groups. Conclusion: Outcomes of the study are indicative of sleep deprivation in adolescent students. This information can help us to further understand the sleep-related differences in the behavior of adolescent and young adults. This can aid in devise a better work schedule to optimize their performance.

Acceptance and Commitment Therapy (ACT) Improves Sleep Quality, Experiential Avoidance, and Emotion Regulation in Individuals with Insomnia—Results from a Randomized Interventional Study

Insomnia is a common problem in the general population. To treat insomnia, medication therapies and insomnia-related cognitive-behavioral interventions are often applied. The aim of the present study was to investigate the influence of acceptance and commitment therapy (ACT) on sleep quality, dysfunctional sleep beliefs and attitudes, experiential avoidance, and acceptance of sleep problems in individuals with insomnia, compared to a control condition. A total of 35 participants with diagnosed insomnia (mean age: 41.46 years old; 62.9% females) were randomly assigned to the ACT intervention (weekly group therapy for 60–70 min) or to the active control condition (weekly group meetings for 60–70 min without interventional and psychotherapeutic character). At baseline and after eight weeks (end of the study), and again 12 weeks later at follow-up, participants completed self-rating questionnaires on sleep quality, dysfunctional beliefs and attitudes about sleep, emotion regulation, and experiential avoidance. Furthermore, participants in the intervention condition kept a weekly sleep log for eight consecutive weeks (micro-analysis). Every morning, participants completed the daily sleep log, which consisted of items regarding subjective sleep duration, sleep quality, and the feeling of being restored. Sleep quality, dysfunctional beliefs and attitudes towards sleep, emotion regulation, and experiential avoidance improved over time, but only in the ACT condition compared to the control condition. Improvements remained stable until follow-up. Improvements in experiential avoidance were related to a favorable change in sleep and cognitive-emotional processing. Micro-analyses showed that improvements occurred within the first three weeks of treatment. The pattern of results suggests that ACT appeared to have improved experiential avoidance, which in turn improved both sleep quality and sleep-related cognitive-emotional processes at longer-term in adults with insomnia.

SleepUp, a Digital Therapeutics Platform for Insomnia

Background: Cognitive-Behavioral Therapy for Insomnia (CBTi) is the gold-standard treatment for chronic insomnia. Although effective, CBTi is not easily accessible due to a shortage of specialized professionals and high treatment costs. Online CBTi (CBTi-O) has been proposed as a more accessible and affordable treatment option. CBTi and CBTi-O are equally effective, and some apps have already been approved by regulatory agencies in USA (Somryst™) and UK (Sleepio™). Objetives: SleepUp is a digital therapeutics solution for insomnia, intended to provide evidence-based treatment in an easily accessible format. Methods: The treatment program is based on CBTi-O, composed by seven therapeutic modules (sleep hygiene, relaxation and meditation, psychoeducation, stimulus control, cognitive restructuring, sleep restriction and paradoxical intention). Users are monitored with a sleep log and validated questionnaires assessing insomnia symptoms, sleepiness, sleep quality and sleep hygiene. Additional therapy modules are included, encompassing mindfulness and other meditation techniques. For refractory cases or for those with comorbidities, remote appointments with medical doctors and psychologists specialized in sleep medicine are available. Results: SleepUp is an early-stage startup and its solutions for sleep and insomnia are being constantly developed and improved. The app is already available in Brazil and USA, both for Android™ and IOS™ devices. Preliminary results demonstrate that the treatment is effective, reducing insomnia symptoms in 28%, (n=1700), improving sleep hygiene scores in 32% (n=100) and increasing sleep efficiency in 16% (n=2500). Conclusion: SleepUp aims at providing a more accessible alternative to the treatment of insomnia, based on CBTI-O, an effective and safe therapeutic approach.