Systematic Review: Chronic pain and insomnia are highly comorbid, and evidence suggests a reciprocal relationship between these. CBT-I has been shown to improve sleep in those with chronic pain, therefore the potential of improved sleep leading to improvements in pain symptoms is a possibility. This led to the question: Does CBT-I improve pain symptoms in those with chronic pain and insomnia? A systematic review of the literature was conducted resulting in eight papers regarding six studies. Evidence was moderate that CBT-I improved sleep and pain related disability, but did not improve self reported pain levels. This discrepancy between improvements in pain related disability and no changes in self-reported pain levels led to the research question for the empirical element of the current thesis. Empirical Element of Thesis Objective: Chronic low back pain (CLBP) is a common form of chronic pain that affects a large population each year. Chronic pain and insomnia are highly comorbid conditions, yet knowledge about how patients perceive their interaction is limited. This qualitative study aims to inform our understanding of the patient experience with particular reference to beliefs and attributions surrounding pain, poor sleep and their interaction. Methods: 11 outpatients from a chronic pain clinic were recruited who suffered CLBP as their main symptom, and who had subsequently developed insomnia as a result. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Qualitative analysis produced five super-ordinate themes: 1) the privacy of pain and solitude of sleep; 2) sleep/pain interaction; 3) night-time thinking; 4) adjustment and acceptance; and 5) self-management. Discussion: The first three themes combine to create the individual experience of CLBP: the visceral, emotional experience; the pre-existing and shifting beliefs; and the thought content. Once this is in place, the individual can reflect on what this means to them, and through acceptance, move through to adjustment. The individual accepts elements of their current experience, but where they see the opportunity to take control, these adjustments are translated into actions relating to self-management. These themes suggest CBT-I should be adapted to include pain specific beliefs to form a CBT for Insomnia and Chronic Pain (‘CBT-CPI’).

STOP-Bang is a tool for predicting the likelihood for sleep-disordered breathing (SDB). In the conventional score, all variables are dichotomous. Our aim was to identify whether modifying the STOP-Bang scoring tool by weighting the variables could improve test characteristics.

The impact of sleep on quality of life (QoL) has been well documented; however, there is a great need for reliable QoL measures for persons with obstructive sleep apnea (OSA). We compared the QoL scores between the 36-Item Short Form of the Medical Outcomes Survey (SF-36), Calgary Sleep Apnea Quality of Life Index (SAQLI), and Functional Outcomes Sleep Questionnaire (FOSQ) in persons with OSA.

UA Open Access Publishing Fund / Background: Medical residency can be a time of increased psychological stress and sleep disturbance. We examine the prospective associations between self-reported sleep quality and resident wellness across a single training year. Methods: Sixty-nine (N69) resident physicians completed the Brief Resident Wellness Profile (M17.66, standard deviation [SD] 3.45, range: 017) and the Pittsburgh Sleep Quality Index (M6.22, SD 2.86, range: 1225) at multiple occasions in a single training year. We examined the 1-month lagged effect of sleep disturbances on residents’ self-reported wellness. Results: Accounting for residents’ overall level of sleep disturbance across the entire study period, both the concurrent (within-person) within-occasion effect of sleep disturbance (B 0.20, standard error [SE]0.06, p0.003, 95% confidence interval [CI]: 0.33, 0.07) and the lagged within-person effect of resident sleep disturbance (B 0.15, SE0.07, p0.037, 95% CI: 0.29, 0.009) were significant predictors of decreased resident wellness. Increases in sleep disturbances are a leading indicatorof resident wellness, predicting decreased well-being 1 month later. Conclusions: Sleep quality exerts a significant effect on self-reported resident wellness. Periodic evaluation of sleep quality may alert program leadership and the residents themselves to impending decreases in psychological well-being.

While sleep loss has been shown to have detrimental effects on cognitive, physiological, and psychological processes, it has only recently been investigated as a possible causal factor of risk-taking behavior (i.e., a conscious choice to engage in dangerous behavior despite knowledge of possible loss or harm). Among the few studies that have been conducted in this field, the majority found that as individuals become sleepier, their propensity to engage in risk-taking behavior increased. The results of the current study indicated a positive relationship between increased sleep loss and two measures of specific risk-taking behavior (i.e., substance use, sexual compulsivity), but no significant relationship between sleep loss and measures of general risk-taking behavior. There was some evidence for temporal stability of the Iowa Gambling Task (IGT), though scores on the IGT were not related to scores on other measures of risk-taking, nor to measures of sleep loss. Negative mood was found to partially mediate the relationship between sleep loss and substance use, as well as the relationship between sleep loss and sexual compulsivity.

Cardiovascular disease is the leading cause of death in the United States. Chronic short sleep duration is also a significant public health problem and has been linked to several markers and outcomes of cardiovascular disease. To date, inconsistency of assessments of sleep duration and insufficiency, use of covariates, and cardiovascular disease measurement across studies limits strong conclusions about the relationship between sleep duration, sleep insufficiency, and cardiovascular disease. The current study examined the association between sleep duration, sleep insufficiency, and a marker of preclinical coronary heart disease (i.e., carotid intima-media thickness) in a community sample using a cross-sectional design. Some evidence for a relationship between sleep duration and cIMT was found, with longer sleep duration predicting higher cIMT in some segments. Additionally, the interaction between sleep duration and sleep insufficiency was significant. However, neither of these effects were significant after adjusting for age and in some cases race/ethnicity, suggesting demographics may explain this association. Actigraphy and sleep diary duration assessments demonstrated significantly different correlations with cIMT in some segments, suggesting the nature of the assessment method may impact the strength or direction of the relationship between sleep duration and cIMT. Limitations and future directions are discussed.

Chronic neuropathic pain, epilepsy, depression and anxiety disorders have been treated successfully with pregabalin. Normal subjects, epileptics and patients with neuropathic pain to whom pregabalin was prescribed showed an improvement in objective and subjective sleep parameters. To determine if pregabalin’s sleep enhancing effect is an independent process, it is necessary to test pregabalin in primary insomniacs who do not have conditions that could be treated by pregabalin. My study was designed as a double blind, randomised, crossover, placebo controlled trial, with 50 milligrams of pregabalin or placebo was administered for eight consecutive nights. I performed polysomnographic recordings on eight female chronic primary insomniacs on five nights. Sleep recordings were performed prior to the intervention, and on the first night and eighth night of each treatment. Subjects filled out subjective scales at baseline and night eight of every treatment. While polysomnography and subjective scales showed that my subjects were insomniac, sleep variables during the pregabalin or placebo period were unchanged when compared to baseline. A daily dose of 50 mg pregabalin did not have any significant effects on either sleep architecture or subjective sleep variables in female chronic primary insomniacs.

Thesis advisor: Elizabeth A. Kensinger / Research in three parts investigated sleep’s preferential consolidation of memories for experiences that are prioritized at encoding due to intrinsic characteristics (e.g., emotion), extrinsic characteristics (e.g., instructed learning, reward), or both. Results showed that sleep broadly strengthens memory for future-relevant information, with these prioritization cues at encoding aiding in the selection process for what is subsequently strengthened during sleep. Part I investigated the effects of sleep on the consolidation of information that was prioritized at encoding due to the intrinsic cue of emotion. Results showed that even once the emotionally salient aspect of the stimuli was removed (i.e., when memory was tested using a neutral cue), residual effects of emotion were reflected in enhanced visual activity following sleep, with this visual activity correlating with the percentage of rapid eye movement sleep obtained during consolidation and likely driven by enhanced occipital-hippocampal connectivity following sleep. This suggests that sleep prioritizes information that was salient due to the intrinsic cue of emotion at encoding, leading to changes in neural activity during retrieval even once that intrinsic cue is no longer present. As in Part I, most prior research has examined how sleep preferentially consolidates memory for information that is salient due to a single cue for future relevance. Part II investigated whether future relevance can be assigned to stimuli via top-down manipulations (i.e., extrinsic prioritization cues), as well as how sleep prioritizes memory for information when intrinsic and extrinsic cues for future relevance co-occur within the same stimuli. Results suggest that when multiple dimensions of future relevance co-occur, sleep prioritizes extrinsic cues (i.e., instructed learning, and to a lesser degree, reward) over intrinsic cues (i.e., emotion). Further, results suggest that additional cues for future relevance do not have additive effects on consolidation, but rather that sleep may binarize information based on whether it is future-relevant or not, preferentially consolidating memory for the former category. Lastly, Part III focused on a manipulation of extrinsic prioritization at encoding to investigate both how the effects of prioritization on memory differ minutes after encoding relative to after long-term consolidation processes take place, and also whether these effects depend on if a healthy versus restricted amount of nocturnal sleep is obtained during the consolidation interval. Results showed that a top-down manipulation of prioritization (i.e., typographical cueing) was effective in enhancing memory; highlighted relative to non-highlighted content was better remembered at multiple time points, with evidence suggesting that N3 (slow-wave) sleep may contribute to these memorial benefits. Together, findings across Parts I-III suggest that sleep selectively strengthens future-relevant information, elucidating which cues for future relevance at the time of encoding lead to enhanced consolidation following sleep, as well as how sleep acts on intrinsic and extrinsic prioritization cues when they co-occur. In identifying intrinsic targets of sleep’s selective consolidation effects, as well as extrinsic manipulations that can be applied to use sleep as a tool to enhance consolidation, these three studies have important implications for optimizing memory that are relevant across domains. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Psychology.

Abstract not available

Thesis (M. Phil.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 158-179).