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.

There is heightened risk for physical and mental health concerns among U.S. veterans. For instance, 26% of veterans experience insomnia (i.e., chronic difficulty initiating or maintaining sleep), compared to 15% of the general population. This may be due, in part, to the presence of post-traumatic stress disorder (PTSD) symptoms, as veterans are twice as likely to be diagnosed with PTSD. Rumination or flashbacks focused on traumatic events (e.g., witnessing death) may contribute to problems with the onset and quality of sleep. However, not all veterans experience insomnia or PTSD symptoms, perhaps due to a positive future orientation (FO). Adaptive, goal-directed thinking may lessen risk for rumination about past actions or experiences (e.g., combat exposure), with consequent beneficial effects on sleep quality. Yet, to the extent that other negative emotions remain in the presence of FO, potential benefits may be thwarted. Specifically, feelings of shame (i.e., judging self as intolerable or defective) or anger may arise from discrepancies between military actions taken or witnessed and one’s moral beliefs. In turn, this may limit future-oriented coping abilities, with negative implications for PTSD symptoms and insomnia. At the bivariate level, we hypothesized that PTSD symptoms, insomnia, shame, and anger would be positively related, and that these variables would be negatively related to FO. At the multivariate level, we hypothesized that PTSD symptoms would mediate the relation between FO and insomnia, such that greater FO would be associated with fewer PTSD symptoms and, in turn, to fewer insomnia symptoms. Further, we hypothesized that shame and anger would moderate these linkages, reducing beneficial effects and exacerbating risk. Our sample of U.S. veterans (n=551) was recruited online from national organizations and social media groups and was primarily white (n=469; 85.1%) and male (n=382; 69.3%). Participants completed self-report measures, including the Zimbardo Time Perspective Inventory - Brief (future subscale), PTSD Checklist - Military Version, Insomnia Severity Index, and Differential Emotions Scale (shame and anger subscales). Bivariate correlations and moderated-mediation analyses, per Hayes (2013), were conducted, covarying age, sex, and ethnicity. In bivariate analyses, all variables were significantly related in hypothesized directions (p<.01). In mediation analyses, the total effect of FO on insomnia was significant (t=-5.336, p<.001), and the direct effect was nonsignificant when PTSD was added (t=-1.840, p=.07), indicating mediation. In moderated-mediation analyses, the PTSD-insomnia linkage was strengthened by shame (b2=-.011, t=-2.451, p=.015, CI=[-.019, -.002])and anger (b2=-.012,t=-3.1, p=.002, CI=[-.020, -.005]), in separate models. In our veteran sample, to the extent one is future-oriented, PTSD symptoms may be ameliorated, with consequent beneficial impact on sleep quantity and quality. Yet, shame and anger may exacerbate the linkage between PTSD symptoms and insomnia, suggesting that therapeutic interventions to reduce shame (e.g., Acceptance and Commitment Therapy) and anger (e.g., cognitive reframing) may promote better sleep. Clinical strategies to promote positive future-oriented thinking (e.g., Cognitive Processing Therapy) may also help to alleviate PTSD symptoms and associated insomnia within the veteran population.

Indiana University-Purdue University Indianapolis (IUPUI) / While insomnia/sleep disturbance has been identified as an independent predictor of cardiovascular disease in the general population, no studies have examined whether insomnia contributes to the elevated cardiovascular disease (CVD) risk in people with human immunodeficiency virus (HIV). Thus, the current study examined whether insomnia symptoms predict incident atherosclerotic CVD in the Veterans Aging Cohort Study 9 (VACS9), a prospective cohort of HIV-infected (n = 3,138) and uninfected (n = 3,010) Veterans utilizing self-report measures and administrative data. In partial support of my hypotheses, I found that HIV-infected Veterans bothered a lot by difficulty falling or staying asleep have greater CVD risk than HIV-infected Veterans without these symptoms. This study failed to replicate previous findings that insomnia symptoms are predictive of incident CVD in uninfected adults, which may be due to issues related to the validity of the insomnia symptoms assessment. A number of methodological issues are identified and considered in the interpretation of the current study results. Given the novelty of examining insomnia as a predictor of incident CVD in HIV-infected adults and the limitations of the present study, future research is needed to better elucidate the association between insomnia and future CVD in this population.

Chronic insomnia is a highly prevalent disorder in general and young adult populations, and contributes a significant economic burden on society. Previous studies have shown healthcare utilization (HCU) is significantly higher for people with insomnia than people without insomnia. One limitation with previous research is accurate measurement of HCU in people with insomnia is difficult due to a high co-morbidity of medical and mental health problems as well as varying operational definitions of insomnia. Assessing HCU in people with insomnia can be improved by applying research diagnostic criteria (RDC) for insomnia, using a population with low rates of co-morbid medical/mental health problems, and measuring HCU with subjective, objective, and predictive methods. The current study found young adults with chronic insomnia had greater HCU than normal sleepers, specifically on number of medications, and chronic disease score (CDS) estimates of total healthcare costs, outpatient costs, and predicted number of primary care visits. The presence of a medical and/or mental health problem acted as a moderating variable between chronic insomnia and HCU. Simple effects testing found young adults with chronic insomnia and a medical/mental health problem had the greatest HCU followed by normal sleepers with a medical/mental health problem, chronic insomnia, and normal sleepers. Exploratory analyses found young adults with chronic insomnia had a greater likelihood of emergency room visits and overnight hospital admissions. More efforts for early identification and intervention of insomnia are necessary to help reduce costs associated with chronic insomnia co-morbid with medical and/or mental health problems.

Insomnia is defined as difficulty initiating or maintaining sleep, or nonrestorative sleep that lasts for at least one month and is accompanied by significant impairment in daytime functioning including fatigue, irritability, and/or difficulty concentrating. It is one of the most common complaints reported by individuals with cancer, especially around the time of cancer diagnosis and treatment. Yet it is often unrecognized and untreated, leading to adverse health consequences and increased healthcare costs. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recommended as the gold standard for treating insomnia among individuals with cancer. Multiple studies have tested and proven the efficacy and effectiveness of CBT-I among individuals with cancer. However, only one study has investigated the efficacy of CBT-I in individuals newly diagnosed with cancer who are undergoing cancer treatment. Moreover, previous studies have been limited by their focus on largely homogenous samples of White, well-educated women with breast cancer. The dissemination of CBT-I among individuals with cancer is greatly limited by the lack of available providers and resources needed to implement the standard face-to-face treatment. One strategy to address this shortage has been to abbreviate standard CBT-I into low-intensity modalities that require fewer resources and can be self-administered on the Internet. The current study sought to examine the feasibility and acceptability, as well as the efficacy of one such program, an online low-intensity CBT-I intervention, Sleeping Healthy Using the Internet (SHUTi), supplemented with clinician support, in a sample of individuals newly diagnosed with heterogeneous malignancies who were undergoing chemotherapy and/or radiation. Results yielded support for the feasibility and acceptability of addressing individuals’ insomnia with a low-intensity CBT-I intervention while they are undergoing cancer treatment. With regard to sleep, there were significant treatment effects observed on a global measure of insomnia severity and on subjective sleep consolidation. There were also significant treatment effects for depressive symptoms. Findings are discussed in the context of study limitations and for the purpose of expanding the literature on disseminating CBT-I early in the cancer care trajectory.

Introdução: A insônia está entre os mais frequentes transtornos que afetam a população na contemporaneidade, devido a mudanças hormonais e psicossociais importantes é muito prevalente na perimenopausa. Há uma relação ainda pouco estudada entre eficiência do sono e prática meditativa. Os tratamentos utilizados para insônia normalmente são de alto custo e paliativos. Objetivo: Avaliar o efeito da meditação na insônia (causada por sintomas característicos da perimenopausa) e qualidade de vida nesta fase da vida. Método: Ensaio clínico controlado para avaliar os efeitos da meditação em mulheres com insônia no período da perimenopausa e o impacto na qualidade de vida em 8 semanas de intervenção. O estudo foi realizado de abril a julho de 2013 com 33 mulheres na perimenopausa de idade entre 40 a 55 anos em 3 unidades de órgão público no município de São Paulo, SP. As participantes foram divididas aleatoriamente em dois grupos, um que praticou somente Higiene do Sono-HS (n=15) e outro que praticou Meditação + Higiene do Sono-M+HS (n=18). Foram realizados encontros semanais com as participantes de ambos os grupos para pratica de meditação em grupo e/ou critérios de higiene do sono. O grupo M+HS também realizou prática diária de meditação. Para avaliar a significância estatística das diferenças de médias antes e depois das intervenções em cada grupo foi utilizado o teste de Wilcoxon. Resultados: Houve melhora da insônia em ambos os grupos, no entanto comparando as diferenças de escore do Índice de Gravidade de Insônia entre os grupos estudados, o grupo M+HS teve um efeito superior em ambas as medições em relação ao grupos HS. No grupo M+HS, houve redução estatisticamente significativa nas categorias do Índice Menopausal de Kupperman: Palpitação, Parestesia e a Pontuação Total já no grupo HS não houve redução significativa em nenhum parâmetro do Índice de Kupperman. Houve melhora significativa da pontuação geral de qualidade de vida aferida pelo WHOQOL breve no grupo M +HS, e no grupo HS houve melhora no domínio relações sociais. Conclusão: Os resultados sugerem que a meditação pode ser ferramenta útil no tratamento da insônia primária durante o período da perimenopausa. A qualidade de vida durante este período também é favorecida de maneira global pela prática diária de meditação. / Introduction: Insomnia is one of the most common disorders that affect the population in contemporaneity, because of important hormonal and psychosocial changes is very prevalent in perimenopause. There is a still understudied relationship between sleep efficiency and meditative practice. The treatments for insomnia are usually expensive and palliative. Objective: Evaluate the effects of meditation in insomnia (caused by typical symptoms of perimenopause) and quality of life in this phase of life. Method: controlled clinical trial to evaluate the effects of meditation in women with insomnia during perimenopause and impact on quality of life in 8-week intervention. The study was conducted from April to July 2013 with 33 perimenopausal women aged between 40-55 years in 3 units of public organization in São Paulo, SP, Brazil. The participants were randomly assigned to two groups, one who performed only Sleep Hygiene-HS (n = 15) and another who performed Meditation + Sleep Hygiene - SH + M (n = 18). Weekly meetings were held with the participants of both groups to practice meditation in a group and / or criteria for the sleep hygiene. The M + SH group also performed daily meditation practice. To assess the statistical significance of differences in means before and after the interventions in each group, the Wilcoxon test was applied. Results: Improvement of sleep quality in both groups, however comparing the differences in the scores of the Insomnia Severity Index between groups, group M + SH had a greater effect on both measures compared to the SH group. In M + SH group showed a statistically significant reduction in the categories of the Kupperman Menopausal Index: palpitations, paresthesia and Total Score, already in the SH group there was no significant reduction in any parameter of the Kupperman Index. A Significant improvement in overall quality of life (measured by WHOQOL-brief) score in group M + HS, and HS group had improvement in social relationships domain. Conclusion: The results suggest that meditation can be useful tool in the treatment of primary insomnia during the perimenopause. The quality of life during this period is also favored globally by daily meditation practice.

Introdução: A insônia está entre os mais frequentes transtornos que afetam a população na contemporaneidade, devido a mudanças hormonais e psicossociais importantes é muito prevalente na perimenopausa. Há uma relação ainda pouco estudada entre eficiência do sono e prática meditativa. Os tratamentos utilizados para insônia normalmente são de alto custo e paliativos. Objetivo: Avaliar o efeito da meditação na insônia (causada por sintomas característicos da perimenopausa) e qualidade de vida nesta fase da vida. Método: Ensaio clínico controlado para avaliar os efeitos da meditação em mulheres com insônia no período da perimenopausa e o impacto na qualidade de vida em 8 semanas de intervenção. O estudo foi realizado de abril a julho de 2013 com 33 mulheres na perimenopausa de idade entre 40 a 55 anos em 3 unidades de órgão público no município de São Paulo, SP. As participantes foram divididas aleatoriamente em dois grupos, um que praticou somente Higiene do Sono-HS (n=15) e outro que praticou Meditação + Higiene do Sono-M+HS (n=18). Foram realizados encontros semanais com as participantes de ambos os grupos para pratica de meditação em grupo e/ou critérios de higiene do sono. O grupo M+HS também realizou prática diária de meditação. Para avaliar a significância estatística das diferenças de médias antes e depois das intervenções em cada grupo foi utilizado o teste de Wilcoxon. Resultados: Houve melhora da insônia em ambos os grupos, no entanto comparando as diferenças de escore do Índice de Gravidade de Insônia entre os grupos estudados, o grupo M+HS teve um efeito superior em ambas as medições em relação ao grupos HS. No grupo M+HS, houve redução estatisticamente significativa nas categorias do Índice Menopausal de Kupperman: Palpitação, Parestesia e a Pontuação Total já no grupo HS não houve redução significativa em nenhum parâmetro do Índice de Kupperman. Houve melhora significativa da pontuação geral de qualidade de vida aferida pelo WHOQOL breve no grupo M +HS, e no grupo HS houve melhora no domínio relações sociais. Conclusão: Os resultados sugerem que a meditação pode ser ferramenta útil no tratamento da insônia primária durante o período da perimenopausa. A qualidade de vida durante este período também é favorecida de maneira global pela prática diária de meditação. / Introduction: Insomnia is one of the most common disorders that affect the population in contemporaneity, because of important hormonal and psychosocial changes is very prevalent in perimenopause. There is a still understudied relationship between sleep efficiency and meditative practice. The treatments for insomnia are usually expensive and palliative. Objective: Evaluate the effects of meditation in insomnia (caused by typical symptoms of perimenopause) and quality of life in this phase of life. Method: controlled clinical trial to evaluate the effects of meditation in women with insomnia during perimenopause and impact on quality of life in 8-week intervention. The study was conducted from April to July 2013 with 33 perimenopausal women aged between 40-55 years in 3 units of public organization in São Paulo, SP, Brazil. The participants were randomly assigned to two groups, one who performed only Sleep Hygiene-HS (n = 15) and another who performed Meditation + Sleep Hygiene - SH + M (n = 18). Weekly meetings were held with the participants of both groups to practice meditation in a group and / or criteria for the sleep hygiene. The M + SH group also performed daily meditation practice. To assess the statistical significance of differences in means before and after the interventions in each group, the Wilcoxon test was applied. Results: Improvement of sleep quality in both groups, however comparing the differences in the scores of the Insomnia Severity Index between groups, group M + SH had a greater effect on both measures compared to the SH group. In M + SH group showed a statistically significant reduction in the categories of the Kupperman Menopausal Index: palpitations, paresthesia and Total Score, already in the SH group there was no significant reduction in any parameter of the Kupperman Index. A Significant improvement in overall quality of life (measured by WHOQOL-brief) score in group M + HS, and HS group had improvement in social relationships domain. Conclusion: The results suggest that meditation can be useful tool in the treatment of primary insomnia during the perimenopause. The quality of life during this period is also favored globally by daily meditation practice.

<p>Syftet med denna litteraturstudie var att beskriva omständigheter som påverkade sömnen hos äldre samt vilka icke-medicinska omvårdnadsåtgärder som kan göras för att lindra sömnproblem. Äldre i studien var personer över 60 år, men det var ingen åldersbegränsning i urvalet av studierna. För att besvara frågeställningarna genomfördes en litteratursökning i databaserna Medline (Pubmed), Academic search elite, Science Direct utifrån inkulsionkriterierna. Det var 12 empiriska studier som inkluderades och granskades. Resultatet visade att omsändigheter för sömproblem var att vara äldre och att lida av depression. Yttre omsändigheter som påverkade sömnen var ljud, ljus, obekväm temperatur i rummet och okänd miljö. Inre omständigheter var inkontinens, mindre rölighet, nedsatt kognitiv förmåga, mediciner och smärta. Förebyggande omständigheter var aktivitet på dagen och tillfredställande socialt liv. Lindrande omständigheter på sömnproblemen var självvald musik. Varma och neutrala sockor hjälpte inte äldre personer med sömnproblem, men minskade insomningstiden hos äldre personer utan sömnproblem.</p> / <p>The aim of this literature review was to describe circumstances that affect the sleep in elderly people and to determine which non-pharmacological treatments that can be used to relive sleep disorder. Elderly in the review were people over 60 years, but there where no agelimitations in the selection of the studies. To answer the questions at issue a literature review was done in the following databases, Medline (Pubmed), Academic search elite and Science Direct on the basis of the inclusion criteria’s. There were 12 empirical studies that were included and reviewed. The result showed that circumstances for sleep disorder were to be old and to be depressed. External circumstances that affects the sleep: were noise, light, uncomfortable temperature in the room and an unknown environment. The internal circumstances were incontinence, reduced mobility, impaired cognitive capacity, medication and pain. Preventing circumstances were daytime activity and a satisfying social life. Alleviating circumstance on sleep disturbance was self selected music. Warm and neutral socks did not relive sleep problems in the elderly people with sleep problems, but relived on-set time in the elderly people without sleep problems.</p>

Syftet med denna litteraturstudie var att beskriva omständigheter som påverkade sömnen hos äldre samt vilka icke-medicinska omvårdnadsåtgärder som kan göras för att lindra sömnproblem. Äldre i studien var personer över 60 år, men det var ingen åldersbegränsning i urvalet av studierna. För att besvara frågeställningarna genomfördes en litteratursökning i databaserna Medline (Pubmed), Academic search elite, Science Direct utifrån inkulsionkriterierna. Det var 12 empiriska studier som inkluderades och granskades. Resultatet visade att omsändigheter för sömproblem var att vara äldre och att lida av depression. Yttre omsändigheter som påverkade sömnen var ljud, ljus, obekväm temperatur i rummet och okänd miljö. Inre omständigheter var inkontinens, mindre rölighet, nedsatt kognitiv förmåga, mediciner och smärta. Förebyggande omständigheter var aktivitet på dagen och tillfredställande socialt liv. Lindrande omständigheter på sömnproblemen var självvald musik. Varma och neutrala sockor hjälpte inte äldre personer med sömnproblem, men minskade insomningstiden hos äldre personer utan sömnproblem. / The aim of this literature review was to describe circumstances that affect the sleep in elderly people and to determine which non-pharmacological treatments that can be used to relive sleep disorder. Elderly in the review were people over 60 years, but there where no agelimitations in the selection of the studies. To answer the questions at issue a literature review was done in the following databases, Medline (Pubmed), Academic search elite and Science Direct on the basis of the inclusion criteria’s. There were 12 empirical studies that were included and reviewed. The result showed that circumstances for sleep disorder were to be old and to be depressed. External circumstances that affects the sleep: were noise, light, uncomfortable temperature in the room and an unknown environment. The internal circumstances were incontinence, reduced mobility, impaired cognitive capacity, medication and pain. Preventing circumstances were daytime activity and a satisfying social life. Alleviating circumstance on sleep disturbance was self selected music. Warm and neutral socks did not relive sleep problems in the elderly people with sleep problems, but relived on-set time in the elderly people without sleep problems.

Traditional treatment for insomnia has been chemotherapy-- despite short-term value and side effects. Need for an alternative has led to research on behavioral treatment methods for insomnia. Relaxation training has consistently produced effective results, but the limited research on biofeedback and stimulus control suggests that they too may be viable alternate treatment methods. The present research investigated electromyogram (EMG) biofeedback, pseudo-EMG biofeedback, relaxation, training, and stimulus control as methods of treating sleep-onset insomnia. Volunteers consisting of 12 males and 24 females were recruited through newspaper advertisements. Subjects had no known physical cause for insomnia and were either free of sleeping medication or kept their dosage constant during the study. Subjects were matched for age and sex, randomly assigned to one of the four treatment groups, then randomly assigned to one of three therapists. Results indicated that pretreatment EMG scores for the four groups were high but not significantly different-- while post treatment EMG scores were not significantly reduced. Pretreatment sleep-latency measures were high, but not significantly different from each other. Post treatment latency measures were significantly reduced, but not significantly different from each other. Correlation between EMG-change scores and sleep-latency-change measures was non-significant. Pretreatment nightly awakenings for the four groups were not significantly different. Post treatment awakenings for the four groups were significantly reduced, but not significantly different from each other. There were not significant interactions for therapist or treatment with any of the dependent variables.