Previous research suggested that sleep onset insomnia was significantly reduced with the use of relaxation techniques; however, the majority of these studies used college student populations with mild to moderate insomnia. The objective of the present study was to assess the effectiveness of using muscle relaxation training in a clinical population known to have sleeping difficulties—cancer patients. Results of this study suggest that muscle relaxation training is an effective technique to reduce sleep onset insomnia in cancer patients, and perhaps also in any clinical group. The technique seems especially promising since it was shown to be effective with severe insomniacs suffering severe medical problems. Results of the study were discussed in terms of possible explanations for the efficacy of the treatment, potential uses of the technique with other clinical populations, and ease of teaching nonpsychologist health professionals to treat with muscle relaxation training.

Interviews conducted with patients receiving treatment for insomnia at one of two sleep medicine clinics, located in Texas and Oregon, suggest that work is a pivotal influence in shaping the respondents' interpretations, explanations and behaviors relating to insomnia. "Work" includes such facets as the nature of one's occupation, the associated volume or amount of work required, mental demands related to work, work schedules and work-related stress. Specifically, results reveal: 1) nearly 60% of the sample identify work as a primary or perpetuating cause of their insomnia, 2) respondents often report work as influencing the nature and importance of their sleep, 3) sleep is considered a problem, and medical intervention is solicited, after work is affected, and 4) work performance is a major consideration in determining treatment efficacy and compliance.

Recent research found insomnia is a risk factor for psychiatric disorders in adults. To see if the same would be true in adolescents, the current study re-analyzed data from a national longitudinal study collected by ADDHealth that evaluated health behaviors in 4552 adolescents (mean age 14.9 years [SD 1.7]) at baseline and again 7-8 years later (n = 3489) during young adulthood. Insomnia was reported by 9.2% of the adolescents. Cross-sectionally, adolescent insomnia was associated with alcohol, cannabis, non-cannabis drugs, and tobacco use, and depression after controlling for gender and ethnicity. Prospectively, adolescent insomnia was a significant risk factor for depression diagnosis, suicidal ideation, and the use of depression and stress prescription medications in young adulthood after controlling for gender, ethnicity, and significant baseline variable. In addition, a trend was noted for suicidal attempts.

Systematic reviews have consistently found that moderate intensity physical activity levels at or above a threshold value of 150 minutes per week reliably deliver cardiovascular, metabolic and musculo-skeletal health benefits. As a result, this threshold value has been widely adopted as an aspirational, public health goal throughout the world. However, while epidemiological and laboratory studies have established clear links between physical activity and sleep outcomes, the evidence base does not yet provide guidelines on minimum levels of exercise likely to reduce insomnia symptoms and improve sleep quality. Such a guideline, if evidence based, could greatly clarify advice, and accelerate the use of physical activity goals to improve sleep outcomes in behavioural sleep medicine and public health. This thesis examined the current public-health recommendation of 150 minutes of moderate intensity activity per week in relation to sleep outcomes. To commence, it established a population-level pattern of the relationship between levels of physical activity and sleep quality by reviewing relevant epidemiological evidence. Exploratory analyses were then conducted using data from an ongoing longitudinal study of physical activity and health outcomes among older people (aged 65 years and above) in which respondents were classified as walking at or above, or below the recommended threshold of 150 minutes per week. In regression models controlling for health and demographic factors, these analyses showed that higher levels of walking were significantly and independently associated with a lower likelihood of either reporting insomnia symptoms (OR = 0.67 (95% CI = 0.45 0.91) p=0.04), or experiencing poor sleep efficiency (OR = 0.70 (95% CI = 0.52 0.94 p=0.02). Using the same data, the predictive validity of this activity threshold was then confirmed in a 27-year survival analysis which showed a significantly decreased all-cause mortality risk associated with the higher level of walking (HR = 0.75 (95% CI = 0.65 - 0.86) p<0.01). These findings offered proof of concept that physical activity-sleep relationships operated on a continuum, with sleep benefits possible even at relatively low levels of activity. Experimental evidence on the acute and sustained effects of physical activity on sleep quality was then analysed and discussed. Outcomes from this review, together with the preliminary analyses described above, were then used to inform the design of a randomised controlled trial to investigate the effects on sleep quality of increasing physical activity to currently recommended levels among sedentary people with insomnia. A total of 41 sedentary adults meeting DSM-IV criteria for insomnia (30 female; mean age 59.8??9.5) were randomised to a physical activity group (???150 minutes moderate intensity activity/week) or a waiting list control group. The principal outcome was Insomnia Severity Index (ISI) change 6 months post baseline; secondary outcomes were anxiety (using the State Trait Anxiety Inventory) and depression (Beck Depression Inventory II). Physical activity was assessed using Actigraph GTX3+ accelerometers. Outcomes were assessed in univariate general linear models, adjusted for baseline confounders. Activity and sleep assessments did not differ at baseline. At 6 months post baseline the intervention group engaged in 213 min/week of moderate intensity PA, compared to the control group (82 min/week). Compared to the control group, the intervention group showed significant improvement in the ISI score at 6 months F(1,28) = 5.16, p=0.03), adjusted means difference = 3.37, with an adjusted Cohen's d =.78 (95% CI 0.10 1.45). There was a significant improvement in trait anxiety, and depression outcomes post-intervention, F(6,28)=4.41, p=0.05, and F(6,28)=5.61, p=0.02, respectively. The results showed that increasing activity in line with current guidelines could deliver clinically significant improvements in sleep quality and mood outcomes among inactive adults with insomnia. While the effect sizes are modest, the pattern of results reported here allow for two conclusions with clear implications for public health: 1) measures to increase levels of physical activity above the currently recommended threshold of 150 minutes per week could usefully be added to other approaches to insomnia management; and 2) the likelihood of improved sleep quality should be routinely added to those evidence-based cardiovascular and metabolic benefits most frequently associated with increased physical activity in behaviour change initiatives.

Comorbid chronic insomnia was found highly prevalent in breast cancer patients. It also persisted through survivorship. Negative emotions upon diagnosis and during the course of cancer treatment might complicate the underlying mediating factors between stress and insomnia found in non-cancer population. Cognitive Behavioural Therapy (CBT) has been evidenced in improving insomnia. With the appreciation of Mindfulness training in improving cognitive flexibility and rumination, a novel treatment approach integrating CBT and mindfulness—Mind-Body Intervention (MBI) was developed. 　　　There were three objectives in the research. Firstly, prevalence data on insomnia and clinical profile of Hong Kong Chinese breast cancer survivors were obtained. Secondly, the mediating roles of negative emotions, hyperarousal, pre-sleep arousals in the relationship between perceived stress and insomnia were examined. Thirdly, the effects of CBT and MBI for breast cancer survivors with insomnia were investigated. 　　　In the first study, 1049 women who survived from non-metastatic breast cancer were invited to complete a survey on stress, mental health, arousals and insomnia. Those who met psychophysiological insomnia were invited to participate in the second study, which was a multisite randomized controlled trial. The 73 participants were allocated to CBT (n=24), MBI (n=27) or waiting list control, WLC (n=22). Both treatments were five weekly-session group therapies. Outcomes on insomnia, mental health, arousals, dysfunctional beliefs, quality of life and mindfulness, were obtained on baseline, post-treatment, 3-month and 6-month follow-ups. 　　　Results of the first study revealed 34.6% of the participants suffered from clinical insomnia, while 15.1%, 27.4% and 12.8% endorsed moderate to extremely severe depression, anxiety and stress respectively. Duration of insomnia was correlated with insomnia severity. Hyperarousal was found moderating cognitive ore-sleep arousal and anxiety, these in turn, together with depression mediated the relationship between perceived stress and insomnia severity. Results of the second study supported the hypothesis both CBT and MBI improved insomnia and other psychological symptoms, while WLC did not. After treatment, significant decreases of 59 and 67 minutes of total wake time per night were found for CBT and MBI respectively. Sleep efficiency values significantly increased in CBT (12.2%) and MBI (12.7%). Moderate to large effect sizes and clinically significant differences were found in most sleep and psychological variables. Generally, CBT produced larger effect sizes than MBI on post-treatment. The therapeutic gains were found sustaining through 3-month to 6-month follow-ups in both treatments. However, the effect sizes of CBT were on the declining trend, while those of MBI were more stable. 　　　The results suggested that insomnia and anxiety were frequently experienced in breast cancer even after completing the medical treatments. The longer the survivors suffered from insomnia, the higher the severity was found. In additional to the cognitive pre-sleep arousal, the important mediating roles of depression and anxiety imply that insomnia treatments should incorporate strategies designed to help in decreasing rumination/worry before bedtime and improving mental health conditions. The findings also provided initial evidence for the efficacy of MBI as a viable treatment for insomnia. More vigorous randomized controlled trial and the long-term efficacy could be further studied. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

In a 9-month prospective study, sleep and daytime functioning were compared in a community sample of 86 participants aged 25-50 years: 43 meeting DSM IV criteria for primary insomnia (26 women & 17 men); and 43 controls (32 women & 11 men). Assessments were conducted at baseline, 4 and 8 months, and included: the Pittsburgh Sleep Quality Index; Spielberger StatefTrait Anxiety Inventory; Eysenck Personality Questionnaire, Beck Depression Inventory; Fatigue Severity Scale; SF-36; Epworth Sleepiness Scale; Dysfunctional Beliefs About Sleep Scale; Sleep Hygiene and Practices Scale, Sleep Disturbance Questionnaire and the Psychomotor Vigilance Task PVT. An instrument to assess the occupational consequences of insomnia (the Occupational Impact of Sleep Questionnaire; OISQ) was also developed in the course of the study. PWI versus control group comparisons were made with repeated measures multivariate ANOVAs. Differences were consistently and significantly maintained on measures of state (F = 15.85 P <0.001) and trait anxiety (F = 23.46; P < 0.001), depression (F = 18.37; P < 0.001), fatigue (F = 22.20; P < 0.001), and neuroticism (F = 11.09; P < 0.001). Among PWI, mental health (F = 14.04; P < 0.001), pain (F = 6.92; P < 0.001), role-emotion (F = 10.94; p < 0.001), general health perceptions (F = 4.77; P < 0.05), social functioning (F = 6.58; P < 0.01) and energy and vitality (F = 32.08; P < 0.001), on the SF-36, were consistent with inferior health related QoL. In addition, pre-sleep arousal (F = 14.76; P < 0.001), sleep hygiene (F = 35.26; P < 0.001) and sleep disturbance (F = 72.32; P < 0.001) were significantly worse within PWI. Subjectively reported TIB (F = 9.38; P < 0.01), SOL (F = 11.17; P < 0.01) and WASO (F = 21.10; P < 0.001), remained greater within PWI, with SE (F = 15.29; P < 0.001), TST (F = 9.38; P < 0.01) and subjective sleep quality (F = 29.57; P < 0.001) greater within controls. Data averaged over the duration of data collection (252 days) found PWI reported an average SOL >30 minutes, an average WASO of> 30 minutes, SE < 80%. Analysed in terms of night to night sleep quality, both PWI and controls showed a pattern of 'good' (sleep efficiency >80%) and 'poor' (sleep efficiency <80%) nights. However, the probability of individual poor nights remained consistently and significantly higher for PWI across the 9 months of the study. Actigraphy data failed to confirm between group differences in sleep, and correlation with diary measures was low in both groups. PVf performance showed instability. Significant group differences found at baseline, were no longer present at subsequent data collection points. Data support the inconsistency surrounding objective performance among PWI within the literature. However, the inconsistency can be attributed to greater change within control participant's performance, rather than within PWI. Data identified the existence of a stable subgroup of PWI reporting symptoms of daytime sleepiness. Daytime sleepiness was found to be a temporally stable feature for this sub-group of PWI, who also Showed a distinctive psychological profile compared to PWI who did not report daytime sleepiness. No difference, however, was observed in subjectively reported sleep structure, quality or daytime performance between these subgroups of PWI. Insomnia subgroup analyses suggest a trait-like difference between sleepy and non sleepy PWI.The OISO showed an acceptable level of internal consistency reliability (alpha 0.93); and successfully discriminated between PWI and controls. The OISO also showed consistent correlations with measures of global sleep quality and subjective sleep parameters. Expressed in terms of comparative percentage decrement, PWI showed a consistent 10% decrement in subjective occupational performance when compared with controls. The OISO shows that absenteeism and punctuality may not capture the full impact of insomnia on workplace performance.

Sömn är en livsviktig funktion för människans välmående och en tredjedel av livet spenderas till att sova. Sömnproblem är ett växande folkhälsoproblem som påverkar det dagliga livet för miljontals människor i världen. Insomni är den vanligaste sömnstörningen och definieras som svårigheter att initiera eller upprätthålla sömn, en icke-rogivande sömn, tidigt uppvaknande, eller en kombination av dessa upplevelser. Syftet med denna litteraturstudie var att beskriva patienters upplevelser av insomni. Resultatet uppkom efter kategorisering av elva vetenskapliga artiklar. Tre teman framkom: försämrat välbefinnande, maktlöshet, och en kamp. Tio kategorier uppstod: att uppleva fatigue, att känna sig ur funktion, att känna oro och ångest, att känna sig fysiskt sjuk, att känna sig utanför, att känna frustration, att känna sig kontrollerad, att inte förstå, att ej vara betrodd och att längta efter bot. I resultatet framkommer det att insomni upplevs som en kamp mot fatigue och ohälsa. Besvär med insomni styrde det dagliga livet samt begränsade möjligheten till uppnådd livskvalité. Upplevelsen av att inte känna sig betrodd av sjukvården var framträdande hos patienter med insomni. Ökad kunskap om hur insomni kan upplevas, identifieras och behandlas bör belysas i sjuksköterskans profession för att främja en bättre hälsa hos patienter med insomni. / Sleep is a vital function for peoples’ well-being and one third of life is spent sleeping. Sleep issues are a growing public health problem that affects the daily lives of millions of people worldwide. Insomnia is the most common sleep disorder and is defined as difficulty initiating or maintaining sleep, a non-restful sleep, early awakening, or a combination of these experiences. The purpose of this study was to describe patients' experiences of insomnia. The result arose after a categorizing of eleven scientific articles. Tree themes emerged: impaired well-being, powerless, and a struggle. Ten categories appeared: to experience fatigue, to feel out of function, to feel concern and anxiety, to feel physically ill, feeling like an outsider, to feel frustrated, feeling controlled, not understanding, not being trusted and to long for cure. The result shows that insomnia is experienced as a struggle against fatigue and illness. Trouble with insomnia ruled the daily life and limited the possibility of attaining quality of life. The experience of not being trusted by healthcare was common in patients with insomnia. Increased knowledge of how insomnia can be experienced, identified and treated should be developed in the nursing profession in order to promote better health in patients with insomnia.

Objectives To examine the associations of Intimate partner violence (IPV) with stress-related sleep disturbance (measured using the Ford Insomnia Response to Stress Test [FIRST]) and poor sleep quality (measured using the Pittsburgh Sleep Quality Index [PSQI]) during early pregnancy. Methods This cross-sectional study included 634 pregnant Peruvian women. In-person interviews were conducted in early pregnancy to collect information regarding IPV history, and sleep traits. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CIs) were calculated using logistic regression procedures. Results Lifetime IPV was associated with a 1.54-fold increased odds of stress-related sleep disturbance (95% CI: 1.08–2.17) and a 1.93-fold increased odds of poor sleep quality (95% CI: 1.33–2.81). Compared with women experiencing no IPV during lifetime, the aOR (95% CI) for stress-related sleep disturbance associated with each type of IPV were: physical abuse only 1.24 (95% CI: 0.84–1.83), sexual abuse only 3.44 (95%CI: 1.07–11.05), and physical and sexual abuse 2.51 (95% CI: 1.27–4.96). The corresponding aORs (95% CI) for poor sleep quality were: 1.72 (95% CI: 1.13–2.61), 2.82 (95% CI: 0.99–8.03), and 2.50 (95% CI: 1.30–4.81), respectively. Women reporting any IPV in the year prior to pregnancy had increased odds of stress-related sleep disturbance (aOR = 2.07; 95% CI: 1.17–3.67) and poor sleep quality (aOR = 2.27; 95% CI: 1.30–3.97) during pregnancy. Conclusion Lifetime and prevalent IPV exposures are associated with stress-related sleep disturbance and poor sleep quality during pregnancy. Our findings suggest that sleep disturbances may be important mechanisms that underlie the lasting adverse effects of IPV on maternal and perinatal health.

Clinical research on insomnia has observed that many individuals with this sleep disorder exhibit a significant discrepancy between their subjective reports of symptom severity and objective measures of the same parameters. This study sought to more closely examine this discrepancy by comparing sleep diary estimates with polysomnography data in a population of 60 older adults with comorbid insomnia. Consistent with previous research, results show that participants significantly underestimated sleep efficiency and total sleep time and significantly overestimated sleep onset latency. Participants receiving CBT-I exhibited significantly reduced discrepancy at post-treatment, particularly with regard to sleep latency, compared to those in a Stress Management and Wellness treatment control group. This suggests that the treatment effects observed as a result of CBT can be partly explained by improvements in the accuracy of sleep estimation. Additionally, high discrepancy at baseline was found to be a significant predictor of positive treatment outcome, indicating that sleep misperception is a potential factor in a favorable treatment response to CBT.

<p>Sleep problems are one of the most common health complaints in the population. Furthermore, people often judge good sleep as crucial for everyday well-being and it has been shown that lack of sleep has negative health effects. However, sleep has not been a subject of much sociological study.</p><p>In this study sleep problems are analysed in different ways. First, a cross-sectional analysis is done in order to find out whether sleep problems in the population have increased from 1968 to 2000. Secondly, a longitudinal analysis is done to see how sleep problems pattern from middle-age to old-age. Last, it is analysed whether there are any differences in the sleep patterns from middle-age to old-age for manual workers and non-manuals.</p><p>This study shows that there has been an increase in sleep problems from 1968 to 2000 in the population. However the increase has only affected younger age groups (between the age 19-55), the elderly population is unaffected. The increase is found among both men and women. Longitudinal analyses of a cohort (born 1915-1925) followed from middle-age to old-age (for 34 years) showed that one out of four experienced an onset of sleep problems during the study. This is in line with earlier research stating that insomnia to a large part is age-related. Furthermore, it was found that manual workers had a larger increase of sleep problems across the 34 years than non-manuals, perhaps suggesting an accumulation effect.</p><p>All analyses were separated for gender and women constantly reported more sleep problems than men. This is not surprising since this relation have been found across almost all cultures and times. Nevertheless, in this study no increase of the gender gap was found with advancing age, a relation found in most other studies. However more research is needed to understand the reason behind the gendered nature of sleep problems.</p>