Fatigue is common in the general population, and is the hallmark of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Although the occurrence of sleep difficulties is known to be common in subjects with fatigue, research on insomnia in such subjects is absent. The current study sought to examine the impact comorbid insomnia has on level of fatigue in subjects with chronic fatigue. The aim of this study is to assess the relationship between insomnia and chronic fatigue, and examine if the relationship is affected by the endocrine activity in the HPA axis. The following hypotheses were tested: 1) Do patients with chronic fatigue and comorbid insomnia experience more fatigue than patients with chronic fatigue without comorbid insomnia? 2) Do patients with chronic fatigue and with initially comorbid insomnia experience more fatigue after treatment than chronic fatigue patients without comorbid insomnia? 3) Do patients with chronic fatigue who experience improvement in insomnia after treatment also experience less fatigue by the end of treatment compared with patients who do not experience improvement in insomnia? 4) Is the potential relationship between insomnia and chronic fatigue influenced by the activity of the HPA axis as expressed by variation in cortisol output measured by Trier Social Stress Test for Groups (TSST-G)? The study sample consisted of 75 patients with chronic fatigue. Thirty-three met criteria for insomnia, while 42 did not. While staying at Hysnes Rehabilitation Center in Trondheim, Norway, they received a work-related Acceptance and Commitment Therapy (ACT) treatment intervention lasting 3.5 weeks. In addition, they participated in a standardized stress test (Trier Social Stress Test) pre- and post-treatment. Saliva cortisol samples were collected during the test in order to measure variation in cortisol output. The current finding is the first description of how insomnia in patients with chronic fatigue is associated with higher levels of fatigue (p < .05). Further, this study gives preliminary support indicating that remission of insomnia in patients with chronic fatigue can significantly reduce levels of fatigue (p < .05), and furthermore improve the physiological stress-response (p < .05). These results might encourage clinicians to assess and provide specific treatment for insomnia in patients with chronic fatigue as this might improve their treatment results. An aim for further research should be to investigate the effect of specified treatment for insomnia in patients with chronic fatigue.

Sömnstörningar hos ungdomar anses vara ett växande problem. Det finns misstankar om att ungdomarnas ökade användning av Informations- och Kommunikationsteknik (IKT) är boven i dramat. Ungdomar upplevs spendera en allt större del av sin tid framför datorn, samtidigt som mobilen går varm av samtal och SMS. Det saknas dock utförlig forskning kring sambanden mellan IKT-användande och sömn. Syfte: Att undersöka huruvida ungdomar lider av sömnstörningar och om det i så fall kan kopplas till deras IKT-användande. De frågeställningar som behandlas är hur ungdomars sömnmönster ser ut och om det finns några kopplingar mellan eventuella negativa sömnmönster och deras IKT-användande. Dessutom undersöker vi om det finns några könsmässiga skillnader i sömn och IKT-användandet. Metod: Den metod som används är kvantitativ och datainsamlingen har skett genom en enkät. Urvalet består av 392 elever i årskurs ett från en gymnasieskola i västra Sverige. Enkäten besvarades och samlades in vid ett och samma tillfälle. Datan har bearbetats och analyserats i statistikprogrammet SPSS. Resultat: Analysen av resultaten visar att deltagarna har sömnproblem och att de upplever negativa effekter av dessa sömnproblem. Resultatet visar även att det finns ett samband mellan deltagarnas IKT-användande och dålig sömnkvalité, ju högre användande desto sämre sömn. Det finns inga direkta könsmässiga skillnader gällande sömnmönstret, däremot finns det skillnader gällande IKT-användandet. Slutsats: Undersökningen visar att deltagarna faktiskt lider av sömnproblem, och att användandet av IKT påverkar sömnen. Samtidigt indikerar resultatet att IKT-användning endast är en av flera påverkansfaktorer. Ytterligare forskning behövs för att till fullo förstå de bakomliggande orsakerna till ungdomarnas sömnproblem. / Sömnstörningar hos ungdomar anses vara ett växande problem. Det finns misstankar om att ungdomarnas ökade användning av Informations- och Kommunikationsteknik (IKT) är boven i dramat. Ungdomar upplevs spendera en allt större del av sin tid framför datorn, samtidigt som mobilen går varm av samtal och SMS. Det saknas dock utförlig forskning kring sambanden mellan IKT-användande och sömn. Syfte: Att undersöka huruvida ungdomar lider av sömnstörningar och om det i så fall kan kopplas till deras IKT-användande. De frågeställningar som behandlas är hur ungdomars sömnmönster ser ut och om det finns några kopplingar mellan eventuella negativa sömnmönster och deras IKT-användande. Dessutom undersöker vi om det finns några könsmässiga skillnader i sömn och IKT-användandet. Metod: Den metod som används är kvantitativ och datainsamlingen har skett genom en enkät. Urvalet består av 392 elever i årskurs ett från en gymnasieskola i västra Sverige. Enkäten besvarades och samlades in vid ett och samma tillfälle. Datan har bearbetats och analyserats i statistikprogrammet SPSS. Resultat: Analysen av resultaten visar att deltagarna har sömnproblem och att de upplever negativa effekter av dessa sömnproblem. Resultatet visar även att det finns ett samband mellan deltagarnas IKT-användande och dålig sömnkvalité, ju högre användande desto sämre sömn. Det finns inga direkta könsmässiga skillnader gällande sömnmönstret, däremot finns det skillnader gällande IKT-användandet. Slutsats: Undersökningen visar att deltagarna faktiskt lider av sömnproblem, och att användandet av IKT påverkar sömnen. Samtidigt indikerar resultatet att IKT-användning endast är en av flera påverkansfaktorer. Ytterligare forskning behövs för att till fullo förstå de bakomliggande orsakerna till ungdomarnas sömnproblem.

Made available in DSpace on 2014-08-20T13:57:56Z (GMT). No. of bitstreams: 1 Dissertacao_Everton_Jose_Fantinel.pdf: 361570 bytes, checksum: 358e3247ab150dabf9b0250dfc706290 (MD5) Previous issue date: 2010-10-18 / Insomnia is the most common sleep disorder. It affects millions of people constituting a public health problem with social and individual consequences. This study aimed to evaluate the prevalence of insomnia and its association with sociodemographic, behavioral and drug use. We used a cross-sectional population-based sample of 2732 adults aged 20 years or more living in Pelotas, Brazil. The outcome was operationalized by Insomnia Severity Index. Analysis was adjusted by Poisson regression. The prevalence of insomnia was 28.2% (95% CI: 26.2 to 30.3), with an increased likelihood in women, younger, poorer and do not work people. There was an apparent increase in the prevalence of insomnia in the city over the past ten years, with a marked change in age, becoming more prevalent in young than old. / A insônia é o mais frequente dos problemas relacionados ao sono. Afeta milhões de pessoas constituindo-se em um problema de saúde pública com consequências sociais e individuais. Este estudo teve por objetivo avaliar a prevalência de insônia e sua associação com variáveis sociodemográficas, comportamentais e de uso de medicamentos. Utilizou-se o delineamento transversal de base populacional, com amostra de 2732 indivíduos de 20 anos de idade ou mais, residentes em Pelotas, RS. O desfecho foi operacionalizado através do Insomnia Severity Index. A análise foi ajustada por regressão de Poisson. A prevalência de insônia foi de 28,2% (IC95%: 26,2 30,3), com uma probabilidade aumentada em mulheres, pessoas mais jovens, mais pobres e que não trabalham. Houve um aparente incremento da prevalência de insônia na cidade nos últimos dez anos, com uma marcante mudança de faixa etária, passando a ser mais prevalente em jovens do que em idosos.

Sleep undergoes important changes during adolescence and many teenagers experience problems sleeping. These in turn affect adolescents´ academic, physical and psychosocial functioning. Moreover, there are some indications that sleep problems in this age group may be increasing, possibly as a consequence of societal changes, e.g., internet availability. Research on adolescents´ sleep is growing, but more epidemiological studies are needed to clarify the prevalence of poor sleep, long and short-term outcomes associated with it, and potential risk and protective factors to target in preventive interventions. The aim of this dissertation was to contribute to each of these goals; Study I investigated the longitudinal association between sleep problems, defined as symptoms of insomnia, and school absenteeism; Study II explored the prevalence of poor sleep, defined as sleep deficit, in an adolescent population and psychosocial and contextual factors associated with it, including emotional and behavioral problems, stress, sleep hygiene and technology use; finally, Study III evaluated the short-term effects of a novel universal school-based intervention to improve adolescents´ sleep health. The findings show that poor sleep was strongly related to adolescents´ functioning, including emotional and behavioral problems and school attendance, and that sleep deficit was prevalent in adolescents. This supports the need for prevention. Moreover, sleep deficit was associated with stress, technology use and arousal at bedtime, which may represent important barriers to sleep. A preventive intervention targeting these barriers to promote adolescents´ sleep health was successful with the individuals most at risk. However, it remains to be seen whether these changes will be maintained after the intervention and whether incidence of sleep problems will be lower relative to a control group. Implications for theory and practice are discussed.

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Approximately 2-11% of adolescents report chronic insomnia. The study used an archival data set from ADDHealth that assessed adolescent health and health-related behaviors. Adolescents (N = 4102) provided data at baseline (Time 1) and at 1-year follow-up (Time 2). Participants were excluded if no ethnicity, gender, or insomnia data were given at Time 1 or 2. Females were more likely to report insomnia than males at Times 1 and 2. In addition, adolescents with remitted insomnia were significantly younger than adolescents without insomnia at Times 1 and 2. Analyses found a prevalence of 9.6%, a remittance of 6.2%, an incidence of 4.4%, and a chronicity of 2.9%. At Time 1 and 2, AWI were significantly more likely to have depression, suicidal behaviors, and behavioral problems in school than AWOI. At Time 2, incidence and chronic insomnia increased the risk of depression, suicidal behaviors and behavioral problems in school. Risk and protective factors analyses indicated psychological counseling was associated with both remitted and chronic insomnia and depression was associated with incidence insomnia.

This master thesis focuses on subjectively percieved quality of sleep and its connections - fatigue, daytime sleepiness and insomnia in older age. Attention is brought to psychological methods of sleep measurement in comparison with objective methods (polysomnography and actigraphy). Theoretical part is based on current scientific knowledge of sleep quality and deals with psychological factors that contribute to improvement or reduction of sleep quality in older age. In context with quality of sleep focus is aimed also at presence of insomnia in older age compared to younger age and possibilities of enhancing sleep quality. Overview of subjective and objective methods of measuring sleep quality and other sleep characteristics is part of the theoretical background. Empirical part of the thesis is divided into two sections. First section compares sleep quality, fatigue, daytime sleepiness and insomnia of younger and older adults. This research is based on following questionnaire data: PSQI (Pittsburgh Sleep Quality Index), FSS (Fatigue Severity Scale), ESS (Epworth Sleepiness Scale) and ISI (Insomnia Severity Index). Second section of the research verifies the validity of psychological methods of measuring sleep quality - questionnaires PSQI, FSS, ESS, ISI and sleep diaries of older adults by...

ZIEL: Ermittlung der Stichtagsprävalenz von Insomnie und anderen Schlafstörungen in deutschen Allgemeinarztpraxen sowie Bestimmung hausärztlicher Erkennensraten. METHODIK: Bundesweite Zufallsauswahl von 539 Arztpraxen. Charakterisierung der Arzt- und Praxismerkmale mittels initialer Vorstudie. Darauf folgend eine Stichtagsbefragung aller Hausarzt-Patienten mittels Schlaffragebogen (PSQI) und klinischen Fragen (N = 19155 Fälle) sowie klinisch-ärztliche Beurteilung durch den behandelnden Artz mittels CGI und Fragebogen. ERGEBNISSE: 1. Trotz nur moderater Kompetenzeinschätzungen hinsichtlich Diagnose und Therapie behandeln Hausärzte Insomnien und andere Schlafstörungen vorwiegend selbst, auch wenn diese einen hohen Behandlungsaufwand erfordern. 2. Die Stichprobe kann als typisch für die Hausarzt-Klientel angesehen werden. 3. Schlafstörungen sind der dritthäufigste Konsultationsanlass. Nahezu jeder zweite Patient berichtete, in den vergangenen 2 Wochen unter Schlafbeschwerden gelitten zu haben, 26,5% erfüllten aufgrund der subjektiven Angaben die Studienkriterien (DSM-IV) für Insomnie. 4. Auch die Ärzte beurteilten 46,4% aller ihrer Patienten mittels CGI zumindest als Grenzfälle einer Schlafstörung, 85,6% wurden als chronisch eingeordnet. Die ärtzlich beurteilte Insomnieprävalenz betrug 25,9%, die anderer Schlafstörungen 13,7%. 5. Nur 54,3% aller Insomniepatienten wurden auch als solche vom Hausarzt diagnostiziert. DISKUSSION: Die Studie liefert erstmals bundesrepräsentative, differenzierte epidemiologische Daten zu der Prävalenz, dem Schweregrad, den Einschränkungen und den Verlaufsmustern von Insomnien und Schlafstörungen. Die außerordentlich große Häufigkeit und die zum Teil markanten Defizite hinsichtlich Erkennen und Diagnostik in der primärärztlichen Versorgungen werden diskutiert. / AIM: To estimate the point prevalence of insomnia, recognition and prescription behavior in primary care. METHODS: Nationwide sample of 539 primary care settings along with their characterization (stage 1). Standardized assessment of all attenders (N = 19.155 patients) on the NISAS target day using a sleep questionnaire (PSQI) and additional questions to cover psychosocial and additional clinical variables. All patients were evaluated by the primary care doctors using a standardized clinical appraisal questionnaire, including a CGI-rating. RESULTS: Prevalence insomnia according to DSM-IV was 26.5%. Recognition of presence of any clinically significant sleep disorder was 72%, recognition of insomnia was poor 54.3%. 85.6% of insomnia patients were rated as chronic. Close to 50% of all insomnia cases did not receive a specific insomnia therapy. Herbals, followed by hypnotics and sedatives and antidepressants were the three most frequent treatments applied, psychotherapy was only seldomly indicated. DISCUSSION: NISAS provides for the first time nationally representative estimates of interventions for insomnia in primary care. The relatively low treatment rates and the high proportion of chronic patients receiving longterm prescription of benzodiazepines seem to be critical. Priorities for future agenda to improve this situation are discussed.

Contexte : L’insomnie chronique affecte un nombre important de personnes âgées; environ 34 % de ces derniers se plaignent d’une difficulté persistante à s’endormir. Beaucoup d’aînés se tournent vers la prise d’hypnotiques pour traiter leur insomnie. Plus précisément, vers une certaine classe d’hypnotiques qu’on nomme les benzodiazépines (BZD). Or, la prise de benzodiazépines est associée à plusieurs impacts négatifs sur la santé chez les personnes âgées (fracture de la hanche, mortalité, cancers et déclin cognitif). Par ailleurs, la thérapie cognitivo-comportementale pour insomnie (TCCI) est considérée comme un traitement de première ligne pour le trouble d’insomnie. De plus, elle améliore plusieurs variables de sommeil (latence d’endormissement, durée totale de sommeil, durée d’éveil et efficacité de sommeil). Objectif : L’objectif de cette étude pilote a pour but d’évaluer l’effet de la TCCI sur le sommeil au cours d’un sevrage structuré de benzodiazépines chez des participants âgés de 60 ans et plus. Méthodes : Trente-six (36) participants dont vingt-quatre (24) femmes et douze (12) hommes d’une moyenne d’âge de 69,5 ans (60-90 ans) souffrant d’insomnie chronique et prenant des BZD sur une durée moyenne de 15 ans (1-44 ans) ont effectué une évaluation de leur sommeil approfondie à travers des agendas de sommeil, des actigraphies et des enregistrements polysomnographiques, avant d’être répartis aléatoirement en deux groupes : le groupe thérapie (n = 19) avec un programme de sevrage sur seize semaines associé à huit sessions de TCCI, et un groupe témoin (n = 17) avec un programme de sevrage associé à la remise d’une brochure explicative des étapes d’un sevrage structuré. Les mêmes évaluations de sommeil ont été répétées à l’issue du sevrage des deux groupes. Des ANCOVAs à mesures répétées et des tests de χ2 de Pearson ont évalué l’effet de l’intervention thérapeutique sur les variables de sommeil et le succès de sevrage. 4 Résultats et conclusion : 65 % de la totalité des participants sont arrivés à une cessation complète de leurs BZD (73,68 % des participants du groupe thérapie et 56,25 % du groupe témoin). Selon les valeurs obtenues sur les agendas de sommeil, le groupe thérapie s’est amélioré davantage que le groupe témoin par la réduction de la latence d’endormissement (F = 6,15, ddl = 1, p = 0,02), de la durée d’éveil (F = 10,96, ddl = 1, p < 0,001) et l’augmentation de l’efficacité de sommeil (F = 4,84, ddl = 1, p = 0,03). De surcroît, le groupe thérapie montre une tendance vers une amélioration au niveau de la qualité de sommeil, tel que défini par le questionnaire d’IQSP1 (F = 3,46, ddl = 1, p = 0,06). Ces résultats préliminaires suggèrent un effet bénéfique de la TCCI sur le sommeil, dans le cadre d’un sevrage de benzodiazépines. / Background: Chronic insomnia affects a significant number of the elderly population, with approximately 34% of older adults complaining of persistent difficulty falling asleep. Many of these older adults choose to use hypnotics to treat their insomnia. To be more specific, they tend to use a certain class of hypnotics called benzodiazepines (BZD). However, benzodiazepine use is correlated with several negative health impacts in the elderly (hip fracture, increased risk of mortality, cancer and cognitive decline). In addition, Cognitive behavioral therapy for insomnia (CBTI) is considered the gold standard and the first-line treatment for primary insomnia disorder. In addition, CBTI improves several sleep variables (sleep latency, total sleep time, waking duration and sleep efficiency). Objective: The objective of this pilot study is to evaluate the effect of CBTI on sleep during a structured benzodiazepine withdrawal in participants who are 60 years of age and older. Methods: Thirty-six (36) participants, twenty-four (24) of whom are female and twelve (12) of whom are male with a mean age of 69.5 years (60-90 years) with chronic insomnia and taking BZDs over an average time of 15 years (1-44 years) completed a comprehensive sleep assessment through sleep diaries, actigraphy, and polysomnographic recordings, before being randomly divided into two groups: the therapy group (n = 19) with a 16-week weaning program associated with eight CBTI sessions, and a control group (n = 17) with a weaning program associated with providing an explanatory brochure of the steps of structured weaning. The same sleep assessments were repeated after weaning of both groups. Repeated measures ANCOVAs and Pearson’s χ2 tests evaluated the effect of therapeutic intervention on sleep variables and withdrawal success. 6 Results and conclusion: 65% of all participants reached a complete cessation of their BZDs (73.68% of participants in the therapy group and 56.25% of the control group). According to the values obtained from sleep diaries, the therapy group improved more than the control group in terms of a reduction in the sleep onset latency (F = 6.15, df = 1, p = 0.02), wake after sleep onset (WASO) (F = 10.96, df = 1, p < 0.001) and an increase in the sleep efficiency (F = 4.84, df = 1, p = 0.03). In addition, the therapy group shows a trend toward improvement in sleep quality, as reported by the questionnaire of PSQI2 (F = 3.46, df = 1, p = 0.06). These preliminary results suggest a beneficial effect of CBTI on sleep as part of a program of structured withdrawal from benzodiazepines.

<b>Study 1:</b><div><b>Background:</b> Insomnia may be a risk factor for cardiovascular disease in HIV (HIV-CVD); however, mechanisms have yet to be elucidated. <b>Methods:</b> We examined cross-sectional associations of insomnia symptoms with biological mechanisms of HIV-CVD (immune activation, systemic inflammation, and coagulation) among 1,542 people living with HIV from the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Past-month insomnia symptoms were assessed by the item, “Difficulty falling or staying asleep?,” with the following response options: “I do not have this symptom” or “I have this symptom and…” “it doesn’t bother me,” “it bothers me a little,” “it bothers me,” “it bothers me a lot.” Circulating levels of the monocyte activation marker soluble CD14 (sCD14), inflammatory marker interleukin-6 (IL-6), and coagulation marker D-dimer were determined from blood specimens. Demographic- and fully-adjusted (CVD risk factors, potential confounders, HIV-related factors) regression models were constructed, with log-transformed biomarker variables as the outcomes. We present the exponentiated regression coefficient (exp[b]) and its 95% confidence interval (<i>CI</i>). <b>Results:</b> For sCD14 and D-dimer, we observed no significant associations. For IL-6, veterans in the “bothers a lot” group had 15% higher IL-6 than veterans in the “I do not have this symptom” group in the demographic-adjusted model (exp[b]=1.15, 95%<i>CI</i>=1.02-1.29, <i>p</i>=.03). This association was nonsignificant in the fully-adjusted model (exp[b]=1.07, 95%<i>CI</i>=0.95-1.19, <i>p</i>=.25). <b>Conclusion:</b> We observed little evidence of relationships between insomnia symptoms and markers of biological mechanisms of HIV-CVD. Other mechanisms may be responsible for the insomnia-CVD relationship in HIV; however, future studies with comprehensive assessments of insomnia symptoms are warranted.</div><div><p><b>Study 2:</b></p><p><b>Background:</b> While insomnia has been identified as a potential risk factor for cardiovascular disease in HIV (HIV-CVD), research on the underlying pathophysiological mechanisms is scarce. <b>Methods:</b> We examined associations between 0-to-12-week changes in sleep disturbance and the concurrent 0-to-12-week changes and the subsequent 12-to-24-week changes in markers of systemic inflammation, coagulation, and endothelial dysfunction among people living with HIV (<i>n</i> = 33-38) enrolled in a depression clinical trial. Sleep disturbance was measured using the Pittsburgh Sleep Quality Index. Inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) and coagulation marker D-dimer were determined from blood specimens; endothelial dysfunction marker brachial flow-mediated dilation (FMD) was determined by ultrasound. 0-to-12-week variables were calculated as 12-week visit minus baseline, and 12-to-24-week variables were calculated as 24-week minus 12-week. We constructed multivariate linear regression models for each outcome adjusting for age, sex, race/ethnicity, Framingham risk score, and baseline depressive symptoms. <b>Results:</b> We did not observe statistically significant associations between 0-to-12-week changes in sleep disturbance and 0-to-12-week or 12-to-24-week changes in IL-6, CRP, D-dimer, or FMD. However, we did observe potentially meaningful associations, likely undetected due to low power. For 0-to-12-weeks, every 1-standard deviation (<i>SD</i>) increase, or worsening, in the sleep disturbance change score was associated with a 0.41 pg/mL and 80 ng/mL decease in IL-6 and D-dimer, respectively. For 12-to-24-weeks, every 1-<i>SD</i> increase in sleep disturbance change score was associated with a 0.63 mg/L, 111 ng/mL, and 0.82% increase in CRP, D-dimer, and FMD, respectively. <b>Conclusion:</b> We observed potentially meaningful, though not statistically significant, associations between changes in sleep disturbance and changes in biological mechanisms underlying HIV-CVD over time. Some associations were in the expected direction, but others were not. Additional studies are needed that utilize larger samples and validated, comprehensive assessments of insomnia.</p></div>