*LITERATURE REVIEW* Abstract Background: Insomnia is an increasing public health epidemic, affecting healthy, sub-clinical and clinical populations. Cognitive Behaviour Therapy for insomnia (CBT-I) is the most evidence-based treatment endorsed by the National Institute of Clinical Excellence (NICE) which provides guidance to health and social services in England. Research has demonstrated, however, that CBT-I has low or uncertain efficacy within various populations including those with coexisting health problems and clinical diagnoses. Furthermore, CBT-I is not accessible to most people due to poor prioritisation within services and a paucity of clinicians skilled in insomnia treatment. There is an urgent need to develop alternative interventions for this persistent and highly debilitating complaint. Acceptance based approaches to insomnia including mindfulness-based stress reduction (MBSR) provide an alternative model for holistic treatment of sleep distress. Objectives: This review summarises and synthesises the available literature investigating the effectiveness of MBSR as a treatment for insomnia in community and clinical populations (with some specific populations excluded). Method: Systematic review of all relevant quantitative and qualitative literature to date using PsycINFO, PsycARTICLES and Web of Knowledge databases. Results: 13 relevant articles were included (3 abstracts): randomised control trials (RCTs), experimental, quasi-experimental and qualitative studies. Conclusions: Overall, the limited research in this area was assessed to be of moderate quality and to provide preliminary evidence that MBSR offers an effective intervention for insomnia symptoms and disorder in various populations. The review highlighted the paucity of research specifically MBSR AND INSOMNIA SYMPTOMS 10 investigating the acceptability of MBSR as an insomnia treatment, particularly for more complex presentations. It is possible that MBSR provides holistic and bi-directional benefits for sleep and emotional well-being, however, further research is required to determine how participants experience the course process in relation to their sleep. Keywords: Insomnia, CBT-I, MBSR. *EMPIRICAL PAPER* Abstract: There is an urgent need to improve the availability and acceptability of interventions for insomnia. Low-levels of help-seeking and high levels of functional impairment are often characteristic of individuals with unremitting complaints. Ambivalence about the significance of insomnia and/or a helpless resignation can be further compounded by lack of available treatments and socio-cultural attitudes towards sleep. Insomnia is often complicated with coexisting mental and physical health problems, a syndromal presentation. Theoretical and empirical evidence suggests that eight-week, mindfulness-based stress reduction (MBSR) programmes may offer a holistic intervention to relieve emotional disturbance that may underlie the complaint. This research sought to understand the experience of MBSR for individuals in the community with persistent insomnia, to gain insight into its acceptability. Methods: Holloway and Jefferson’s psychosocial method was used which posits the ‘defended subject’ as key to data construction and analysis (2013). Defences, free associations, researcher-interviewee dynamic, textual information, cultural and sociological knowledge all contributed to an understanding of the ‘whole’ of the experience of interviewees as communicated within Free Association Narrative Interviewing. Results: Results indicate that for highly defended individuals with insomnia, MBSR can be a challenging intervention to engage with and to embody. Barriers to acceptability included: limited insight into emotional distress, (unconscious) relational secondary gains to insomnia, limited understanding of sleep as a physiological process, restricted understanding or misconceptions about mindfulness prior to participation, resistance to acknowledging insomnia MBSR AND INSOMNIA SYMPTOMS 66 as a mental health complaint and practical issues of delivery. Researcher-interviewee dynamics suggested significant unmet relational needs of many interviewees. An exceptional case was discussed where relational distress was not understood to underlie insomnia and where significant benefits to sleep were reported from MBSR. Conclusion: The methodology enabled novel insights into the challenges for highly defended individuals with complex insomnia for accessing MBSR. By contrast, it is possible that for less complex but acute and recurrent insomnia, MBSR is more readily acceptable. Study limitations, future research needs and recommendations for improving the acceptability of MBSR for complex cases of insomnia are discussed.

The present study investigated the effects of progressive relaxation training using an abridged form of Jacobson's (1938) relaxation exercises on the mean number of nocturnal sleep disturbances in a group of psychiatric inpatients. Nocturnal time-sampling observations were made during a 14 day base line to select Ss who averaged 1.5 sleep disturbances per night. Six women, ranging in age from 23 to 56 years, were classified as problem sleepers and were moved to a common bedroom, where a second 16 day base line was taken to control for changes in the nocturnal environment. After a brief introduction and demonstration, a tape recording of the relaxation exercises was played each night of the 20 day experimental period. Results indicate a statistically significant decrease (p < .05) in the mean number of sleep disturbances as compared to base line levels. Caution was suggested in interpreting the results due to the possibility of interaction between the performance of the relaxation exercises, alteration of the nocturnal environment, and Ss' hypnotic drug medication.

Disordered sleep is strongly linked to depression, but reasons for this are not well understood. One possibility is that this link is partially explained by deficits in the emotional processing system. This model is substantiated based on the strong link between sleep and emotions, as well as ties between affect and depression. Therefore, this study tested whether various emotional and non-emotional deficits mediated the link between poor sleep quality and depression. Two hundred undergraduate students were recruited via an online university system. Participants completed self-report scales of depression, sleep quality, emotion recognition, and affective response to pre-tested pleasant or unpleasant stimuli. Mediation models were tested for viable emotion and non-emotion mediators, as well as using other mediators as covariates. The indirect effect for all models was tested using bootstrapping. Only affective response to unpleasant stimuli emerged as a significant mediator of the relationship between sleep quality and depression and accounted for 5% of the variance in that relationship; it remained a mediator after controlling for non-emotion related mediators. Recently, sleep problems have gained attention due to serious consequences for public health, including a strong association with psychological disorders. This study was a first step in testing pathways by which disordered sleep leads to increases in depression symptoms. In our sample, blunted emotional responding to unpleasant images partially accounted for the link seen between sleep and depression. Future research may aim to extend the study of process and pathway-related models, particularly in the realm of emotional responding in the relationship between sleep and depression.

<p>Sömnsvårigheter kan försämra upplevelsen av livskvalité och förekommer även tillsammans med många andra psykiatriska svårigheter. KBT vid primär insomni har visat sig vara en framgångsrik behandling, men majoriteten av de individer som söker hjälp blir endast erbjudna farmakologisk behandling. I syfte att skapa en mer lättillgänglig behandlingsform har en självhjälpsbehandling utarbetats och prövats ut på en liten grupp undersökningsdeltagare med sömnsvårigheter. Det har tidigare gjorts en svensk vetenskaplig studie av internetbehandling av kronisk insomni. Föreliggande studie har ett explorativt syfte, där behandlingen består av sömnrestriktion, stimuluskontroll, avslappning, tankestund och visualisering. Deltagarna får även arbeta med att förändra säkerhets- och stressbeteenden. De 6 deltagare som fullföljde behandlingen uppvisade förbättringar av sömn och dagsymtom på flertalet utfallsmått. Signifikanta förbättringar visade sig på Insomnia Severity Index, Dysfunctional Beliefs and Attitudes about Sleep, samt reducering av skattade dagtidsbesvär. Självhjälpsmanualen kommer till hösten att utvärderas i en kontrollerad studie av Karolinska internetpsykiatri (KIP).</p>

The time of cancer diagnosis and treatment may be marked by an increase in stressors, which may be associated with poorer psychosocial and physical adaptation and increased sleep difficulty. Prior work has shown that psychosocial interventions that teach stress management skills can improve indicators of psychosocial and physical adaptation in women with breast cancer, mostly in cancer survivors who have completed treatment. The extant literature does not examine the effects of stress management on sleep, or the role that sleep plays in mediating psychosocial and physical adaptation outcomes, among women in the midst of treatment for non-metastatic breast cancer (BCa). Two hundred forty (240) women, recruited post-surgery from oncology practices, were randomly assigned to a 10-week group-based cognitive behavioral stress management intervention (CBSM; n = 120) or 1-day psychoeducation (PE) control (n = 120). The intervention consisted of didactics, CBSM techniques, and relaxation exercises, but did not specifically target sleep or sleep quality (SQ). Women assigned to the PE condition attended a one-day group seminar where they learned some of the material covered in the CBSM intervention, without the therapeutic group environment, role play techniques, and home practice. Participants completed self-report questionnaires at baseline, and at 6- and 12-month follow-ups. After controlling for days since surgery, participants in the CBSM group reported improved SQ, as well as increased positive states of mind, decreased disruption in social recreational functioning, and reduced fatigue-related daytime dysfunction for up to 8 - 12 months after baseline. There were marginally significant improvements in functional well-being and social functioning. CBSM was not associated with improvements in fatigue intensity. Improvements in SQ mediated CBSM-associated improvements in positive states of mind, social disruption, and fatigue-related daytime dysfunction. Thus, the CBSM intervention had beneficial effects on several indicators of functional adaptation that were in part explained by improvements in the quality of sleep. Future work should test the combined effects of stress management and sleep management interventions for women initiating treatment for BCa.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 124-131).

Sömnsvårigheter kan försämra upplevelsen av livskvalité och förekommer även tillsammans med många andra psykiatriska svårigheter. KBT vid primär insomni har visat sig vara en framgångsrik behandling, men majoriteten av de individer som söker hjälp blir endast erbjudna farmakologisk behandling. I syfte att skapa en mer lättillgänglig behandlingsform har en självhjälpsbehandling utarbetats och prövats ut på en liten grupp undersökningsdeltagare med sömnsvårigheter. Det har tidigare gjorts en svensk vetenskaplig studie av internetbehandling av kronisk insomni. Föreliggande studie har ett explorativt syfte, där behandlingen består av sömnrestriktion, stimuluskontroll, avslappning, tankestund och visualisering. Deltagarna får även arbeta med att förändra säkerhets- och stressbeteenden. De 6 deltagare som fullföljde behandlingen uppvisade förbättringar av sömn och dagsymtom på flertalet utfallsmått. Signifikanta förbättringar visade sig på Insomnia Severity Index, Dysfunctional Beliefs and Attitudes about Sleep, samt reducering av skattade dagtidsbesvär. Självhjälpsmanualen kommer till hösten att utvärderas i en kontrollerad studie av Karolinska internetpsykiatri (KIP).

Sömnen är ett grundläggande behov hos människan som bland annat ses ha en livsuppehållande och återhämtande funktion på kroppen och psyket. Sömnkvaliteten ändras med stigande ålder och sömnbesvär är vanligt förekommande bland äldre. Syftet med studien var att beskriva ickefarmakologiska behandlingsalternativ, och därmed relaterade effekter, som sjuksköterskan kan tillämpa mot insomnia för äldre. Metoden var en litteraturstudie. Resultatet bygger på en analys av femton artiklar mellan 1990-2006 som sökts via databaserna CINAHL och Medline. Vid analysen växte tre huvudkategorier fram: information, insatsinriktade alternativ samt rutininriktade alternativ med tillhörande underkategorier. Genom att informera patienter om effekter av exempelvis kaffe, tillämpa avslappningsövningar, ändra rutiner samt skapa stimulans under dagtid till patienter med insomnia kan sömnen förbättras på flera sätt. Effekter av den ickefarmakologiska behandlingen mot insomnia är till exempel minskad insomningstid, ökad sovtid, reducerad användning av sömnläkemedel, en större upplevd livstillfredsställelse samt ökad vakenhet dagtid.

Background Insomnia is a common and increasing illness among general population all over the world. With insomnia, patients would more likely to have physical, social dysfunction and mood disorders, and even have increased risk of accidents. Therefore, identifying the harm of insomnia and improving the quality of life of patients are very important. Objectives The objective of this systematic review is to evaluate quality of life in patients affected with insomnia. Particularly focuses on the following two question: 1) How insomnia impact quality of life in patients with insomnia. 2) What factors affect quality of life among people with insomnia, such as demographic factors, physical and psychological factors. Methods Systematic reviewing the articles from 1990 to 2013 in PubMed and Medline, which evaluated the quality of life in patients affected with insomnia, using the keywords “insomnia” AND “quality of life”. Results and Discussion There were 9 articles have been included in this review. The year were ranged from 1998 to 2012,8 out of 9 papers had the average age ranged from 42-57 year old. Insomnia significantly related to all of the eight domains and PCS,MCS of QOL negatively, and both of the severity of insomnia and the number of sleep problems have negative impact on QOL. Moreover, regarding the factors which affect QOL of patients, older, female, not married, smoking, drinking, psychiatric disorders and without treatment were associated with lower QOL. Furthermore, regarding the future directions, in Hong Kong the application of the results in this review is appropriate but still need more studies which evaluating the associated factors of insomniacs’ QOL with validated Chinese version QOL measures. Conclusion There was a negative relationship between insomnia and quality of life, and the severity of insomnia and the number of sleep problems had negative impact on quality of life. Particularly, older, female, single statuse, smoking, drinking, psychiatric disorders had negative influence on patients’s QOL. Regarding the control strategies, using appropriate medical treatment under physician guidance, consultation of mental disorders, increasing the public awareness of the harm of insomnia play a pivotal role in reduce the impairment of insomnia. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Around a third of the general population experience insomnia at some point in their lives. A lack of good quality sleep can negatively impact upon daytime functioning, relationships and behaviour. Although the issues and management of prisoner's mental health has been assessed thoroughly across the prison literature, the importance of poor sleep prevalence, associated causes and its management has failed to be systematically examined. My systematic integrative review of the sleep-prison literature collated and synthesized the evidence, informing the overall study objectives and design. Aim: The overarching aim of this mixed-methods thesis was to produce a treatment pathway to help manage insomnia in a prison population, acceptable to both staff and prisoners. Study 1: A national survey and telephone interviews examining current insomnia management practice in England and Wales prisons. Eight-four prisons took part (73%). The most common interventions were medication and sleep hygiene education. Analysis of telephone interviews revealed four main themes, insomnia as a normal occurrence in prison; the problem of medication in prison; the negative impact of the prison environment; and effective management of insomnia in prison. Study 2: A cross-sectional study looking at prevalence and associated factors of insomnia in male and female prisons was conducted. Two hundred and thirty seven prisoners completed a questionnaire battery. Around two-thirds had insomnia disorder and clinical, environmental and situational factors were much more likely in this group than those without insomnia. Study 3: Semi-structured interviews were conducted with staff and prisoners to explore perspectives of insomnia management. Three themes were found: value of good sleep, barriers and considerations for good sleep management and future direction of insomnia management in prison. Study 4: A modified Delphi consensus study was conducted with academic sleep researchers, prison staff and service users over three rounds of consultation. Consensus was achieved and a stepped-care treatment pathway was produced. Conclusion: When used in future practice, the treatment pathway should help practitioners to identify, assess and manage insomnia in a population that is twice as likely to experience insomnia as the general population.