1. 好睡眠的标准：你真的“睡对了”吗？
你是不是也经常有这样的困惑：明明在床上躺了七八个小时，早上醒来却依然觉得全身疲惫，好像没睡一样？或者晚上早早地爬上床，却翻来覆去好久都睡不着？又或者一晚上醒来好几次，每次都像重新入睡一样困难？如果你有这些情况，那么很可能你虽然“睡够了时间”，但并没有“睡对了”。我们常说的“好睡眠”，可不仅仅是睡够时长那么简单，它背后藏着一套科学的衡量标准。
1.1 睡眠质量的四个核心指标
要判断自己的睡眠是不是真的“好”，我们可以从四个关键指标来评估：睡眠效率、睡眠潜伏期、睡眠持续时间，以及觉醒后清醒时间。
首先是睡眠效率（Sleep Efficiency，SE），这个指标就像是你“躺在床上的时间”里，真正“用来睡觉的时间”占了多少比例 1。举个例子，如果你晚上10点躺下，早上6点起床，总共在床上待了8小时。但这8小时里，你可能花了一个小时才睡着，中间又醒了半小时，那么你实际睡觉的时间就是8小时减去1.5小时，也就是6.5小时。这样一算，你的睡眠效率就是6.5/8 ≈ 81.25%。一般来说，成年人的睡眠效率达到85%以上才算及格，如果低于这个数字，就说明你在床上“磨蹭”的时间太多了，没有充分利用好睡眠时间。
其次是睡眠潜伏期（Sleep Latency，SOL），这个听起来有点专业的词，其实就是指你从“躺下关灯”到“真正睡着”中间所花的时间 2。理想情况下，这个时间应该控制在15到20分钟。如果你一沾枕头就睡着，那说明你可能太累了；但如果你躺在床上超过30分钟还迟迟无法入睡，那就说明你的入睡困难，可能存在失眠问题。很多研究都指出，睡眠潜伏期过长是衡量睡眠质量差的一个重要指标 34。
第三是睡眠持续时间（Total Sleep Time，TST），也就是我们常说的“睡了多久”。对于大多数成年人来说，每晚7到9小时的睡眠是比较理想的，少于7小时就被认为是睡眠不足 567。然而，就像前面提到的，仅仅睡够时间并不意味着睡眠质量就好。如果你的睡眠持续时间足够，但其他指标不达标，你依然会感觉疲惫。例如，一项针对老年人的研究发现，总睡眠时间不足与睡眠障碍的主观报告有关 8。
最后是觉醒后清醒时间（Wake After Sleep Onset，WASO），它指的是你在第一次睡着之后，到早上最终醒来之前，所有醒过来的时间的总和。也就是说，如果你半夜醒来上厕所、喝水，或者只是翻个身又迷迷糊糊地醒了一会儿，这些零零散散的清醒时间都会被计算在内。这个时间越短越好，说明你的睡眠连续性强，睡得越“实”。一项研究表明，较高的觉醒后清醒时间与主观报告的睡眠障碍呈正相关 8。
所以，如果你发现自己虽然“睡够了7小时”，但入睡困难、夜间觉醒频繁、或者躺在床上玩手机的时间比睡觉时间还长，那么很可能你的睡眠质量并不高。这时候，就需要我们从科学的角度出发，好好审视并调整我们的睡眠习惯了。
2. 睡眠破坏者大起底：哪些因素在拖你后腿？
了解了“好睡眠”的标准，接下来我们就要看看，究竟是什么因素在偷偷“破坏”我们的睡眠质量。要知道，很多时候，那些我们习以为常的生活习惯，或者身体上的一些小变化，都可能是导致我们睡不好的“幕后黑手”。
2.1 生理因素：年龄、BMI与昼夜节律的影响
我们的身体是一个精密的仪器，随着时间推移，或者在某些状态下，它会发生一些变化，而这些变化可能就会悄悄影响我们的睡眠。
首先是年龄。我们会发现，小孩能睡得很沉，而老年人似乎总是睡得少、睡得浅。这并不是错觉，而是有科学依据的。随着年龄的增长，我们体内的褪黑素（一种帮助我们入睡的“睡眠荷尔蒙”）分泌会逐渐减少，这就使得老年人更容易出现入睡困难、睡眠片段化的问题 9。此外，大脑中调控睡眠的神经系统也会发生变化，导致睡眠结构不如年轻时稳定 10。
其次是身体质量指数（BMI），也就是我们常说的“胖瘦”。肥胖，尤其是肚子上的脂肪堆积过多，会大大增加患上阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea, OSA）的风险 11。阻塞性睡眠呼吸暂停听起来有点吓人，简单来说，就是睡觉的时候，气道（比如喉咙）会反复塌陷，导致呼吸暂停或者呼吸变浅。想象一下，一个人在睡觉时，呼吸道像被什么东西堵住了一样，大脑会因为缺氧而反复发出“警报”，让人从睡梦中惊醒，即使自己不记得，睡眠的连续性也被严重破坏了。长期下来，这不仅会导致白天嗜睡、注意力不集中，还会增加患高血压、心血管疾病的风险 1213。研究表明，BMI升高与睡眠呼吸暂停、习惯性打鼾、睡眠时间缩短和睡眠质量差的风险增加有关 14。更有趣的是，肥胖与睡眠障碍之间往往是“恶性循环”：睡眠质量差会影响身体的代谢，让人更容易发胖，而肥胖又反过来加重睡眠呼吸暂停等问题，形成一个难以打破的怪圈。近期的一项研究甚至发现，较高的内脏脂肪指数和血脂积累产物（这两种指标都与肥胖相关）会增加患阻塞性睡眠呼吸暂停的风险，这提示我们可以通过饮食和运动干预来降低风险 11。
最后，我们的昼夜节律（Circadian Rhythms）也扮演着关键角色。昼夜节律就像我们身体里的一座24小时“生物钟”，它调节着我们什么时候清醒、什么时候睡觉，什么时候吃饭等等生理活动 15。如果我们的生活作息和这座生物钟“不同步”，比如经常熬夜、倒班工作，或者周末睡懒觉太多（这在科学上被称为“社交时差” Social Jetlag），就会打乱身体的正常节奏。这种昼夜节律的紊乱，不仅会让我们感到疲惫、精神不振，还可能引发一系列健康问题。例如，夜班工作就被发现与多囊卵巢综合征（PCOS）之间存在显著关联，这说明不规律的作息会影响女性的生殖健康 16。而“社交时差”更是一个隐形的健康杀手，它与更高的身体质量指数（BMI）、脂肪量以及肥胖风险显著相关 1718。这提醒我们，保持规律的作息，让身体的生物钟正常运转，对于维持良好的睡眠和整体健康至关重要。甚至有研究发现，睡眠质量差还会加速生物衰老，并且会削弱身体对抗空气污染的能力 19。
2.2 心理与情绪：压力、焦虑的“夜间余震”
除了身体上的变化，我们的心理和情绪状况，也是影响睡眠质量的“隐形杀手”。你有没有过这样的经历：白天工作压力山大，或者心里装着一件烦心事，到了晚上躺在床上，脑子里却像放电影一样停不下来，结果翻来覆去怎么也睡不着？这就是压力和焦虑给睡眠带来的“夜间余震”。
压力和焦虑就像是给大脑打了一针兴奋剂。当我们感到有压力时，身体会分泌皮质醇等应激激素，让心跳加速、呼吸急促，神经系统处于高度警觉状态。这种状态下，大脑很难放松下来进入睡眠模式。一项研究指出，压力与失眠之间存在着双向关系：一方面，长期压力会导致失眠，另一方面，失眠又会加重压力，形成一个恶性循环 20。对于大学生群体来说，学业压力和考试焦虑更是常见的睡眠破坏者。有研究发现，在考试准备期间，医学生中高达59%的人存在临床相关的睡眠障碍，而平时这个比例只有29% 21。另一项针对大学生的调查也显示，情绪和学业压力是影响睡眠质量的重要因素 22。
焦虑和抑郁等负面情绪，会显著延长我们的睡眠潜伏期，也就是让我们花更长的时间才能入睡。因为大脑一直在“反刍”那些令人担忧的事情，或是沉浸在低落的情绪中，无法安静下来。同时，这些情绪还会增加夜间觉醒的次数和时长，让我们的睡眠变得支离破碎。即使睡着了，睡眠质量也会大打折扣，因为大脑在应激状态下，深睡眠和快速眼动睡眠（REM睡眠）的结构都会受到影响。REM睡眠，作为与情绪处理密切相关的睡眠阶段，如果出现不稳定性，就可能加剧情绪问题，形成“失眠-情绪障碍”的恶性循环 23。
值得注意的是，心理因素对睡眠的影响甚至可能比我们想象的更深远。例如，对于那些患有阻塞性睡眠呼吸暂停（OSA）的人来说，心理健康状况还会影响他们对治疗的依从性。有研究显示，心理干预，比如认知行为疗法（CBT），可以显著改善OSA患者对持续气道正压通气（CPAP）治疗的依从性，从而间接提升他们的睡眠质量和整体健康状况。这表明，仅仅治疗生理上的问题可能还不够，心理层面的支持同样至关重要。甚至有研究发现，肠道菌群的调节，通过影响肠-脑轴，也能在一定程度上缓解考试焦虑学生的焦虑、抑郁和失眠症状 24。
所以，想要拥有一个好睡眠，光关注身体健康还不够，学会管理情绪、减轻心理压力，也是我们必须要做好的“功课”。
2.3 环境与行为：室温、屏幕蓝光的隐形干扰
除了生理和心理因素，我们所处的环境和睡前的行为习惯，也常常成为影响睡眠质量的“隐形干扰”。这些干扰可能很微小，但日积月累，足以让我们的睡眠“跑偏”。
首先，室温是影响睡眠舒适度的重要一环。你可能遇到过这样的情况：夏天太热，翻来覆去睡不着；冬天太冷，手脚冰凉难以入睡。这是因为我们的大脑在睡眠时需要将核心体温适当降低，才能更好地进入和维持睡眠状态。如果卧室温度过高或过低，身体为了调节体温就需要消耗额外的能量，这会影响睡眠的深度和连续性。当房间温度超出舒适区时，睡眠就会受到干扰，比如醒来的次数会增多，睡眠效率也会下降。例如，一项关于冷却系统对睡眠质量影响的研究发现，即使室温相似，不同的冷却方法也会通过影响热舒适度来影响主观和客观的睡眠质量，其中辐射冷却系统比对流冷却系统能提供更低的相对湿度和气流，从而带来更高的主观睡眠恢复感和更好的客观睡眠效率、更短的入睡时间 25。婴儿睡眠环境的研究也指出，冬季婴儿卧室环境温度更高且变化更大，支持了反常过热可能发生在部分婴儿身上的假设 26。
其次，睡前使用电子设备是现代人普遍存在的坏习惯，也是睡眠的头号敌人之一。智能手机、平板电脑、电脑等电子产品屏幕会发出大量的蓝光。这种蓝光对我们的大脑来说，就像是白天刺眼的阳光，它会强烈地抑制体内褪黑素的分泌 272829。褪黑素是身体里帮助我们启动“睡眠模式”的信号，它告诉大脑：“天黑了，该睡觉了。”但如果在睡前长时间接触蓝光，大脑就会误以为还是白天，导致褪黑素分泌减少或延迟，结果就是我们入睡困难，睡眠潜伏期延长 283031。
尤其是对于青少年来说，睡前使用电子设备对睡眠的负面影响更为显著。青少年正处于生长发育的关键时期，对蓝光更加敏感，其昼夜节律也更容易受到干扰 32。多项研究表明，青少年睡前使用屏幕时间越长，其睡眠时间越短，睡眠质量越差 333435。例如，一项针对健康人群的研究发现，晚上长时间暴露在屏幕蓝光下，会使得早晨的睡眠惯性更大，工作日的入睡时间更长 30。即使是睡前使用过滤蓝光模式的智能手机，虽然在某些参数上可能影响不显著，但整体上仍然可能对睡眠和认知表现产生负面影响 3637。更糟糕的是，很多青少年在床上玩手机，这种“在床上使用屏幕”的行为，尤其是在进行互动性或多任务处理时，被发现与总睡眠时间缩短密切相关。比如，睡前每多玩10分钟的游戏，总睡眠时间就会减少17分钟 38。这就像是给身体的生物钟按下了“暂停键”，让它无法按时进入休息状态。
除了蓝光，睡前玩电子设备还会让大脑保持兴奋状态，因为沉浸在游戏、社交媒体或短视频中，会刺激大脑分泌多巴胺，使人难以平静下来。这就像是睡前给大脑“加了个班”，自然就难以顺利进入梦乡。所以，如果你想拥有高质量的睡眠，那么睡前远离电子设备，给卧室营造一个黑暗、凉爽、安静的环境，就显得尤为重要。
3. 日常调整：从饮食运动到睡前仪式的科学搭配
了解了睡眠的“敌人”之后，接下来我们就要采取积极的行动，通过调整日常生活中的饮食、运动习惯以及睡前仪式，来帮助我们重新找回高质量的睡眠。这些调整可能看起来简单，但长期坚持下来，会给你的睡眠带来意想不到的惊喜。
3.1 吃对食物：ω-3、镁与“助眠零食”的选择
“民以食为天”，这句话同样适用于睡眠。我们吃进去的食物，不仅为身体提供能量，其中的某些营养成分还能直接或间接地影响我们的睡眠质量。所以，想要睡个好觉，先从“吃”开始调整吧。
首先，色氨酸是帮助我们入睡的“好帮手”。色氨酸是人体必需的一种氨基酸，它是大脑中制造血清素和褪黑素的“原材料” 394041。血清素是一种能让人感到平静和愉悦的神经递质，而褪黑素则是我们身体的“睡眠信号灯”，它在黑暗中分泌，帮助我们进入睡眠状态。因此，多吃富含色氨酸的食物，有助于促进这两种“助眠物质”的生成。
那么，哪些食物富含色氨酸呢？比如坚果（像杏仁、核桃）、乳制品（牛奶、酸奶、奶酪）42、豆制品、鸡肉、火鸡肉和鸡蛋等都是不错的选择 394344。特别是睡前喝一杯温牛奶，不仅能补充色氨酸，还能起到安抚情绪的作用，这可不是老生常谈，而是有科学依据的。
其次，ω-3脂肪酸也是改善睡眠质量的潜力股。这种健康的脂肪主要存在于深海鱼（如三文鱼、金枪鱼、沙丁鱼）中 444546。研究表明，ω-3脂肪酸，特别是其中的EPA和DHA，对改善睡眠质量有一定的积极作用 454647。虽然有些研究对ω-3脂肪酸是否能直接改善更年期女性的睡眠质量持保留态度 46，但从整体健康角度看，摄入足够的ω-3脂肪酸无疑是有益的。它不仅对心血管健康有好处，还能帮助大脑更好地工作。
此外，镁这种矿物质也对睡眠至关重要。镁参与了体内300多种生化反应，其中就包括调节神经系统、放松肌肉，并有助于褪黑素的生成 414748。当身体缺乏镁时，可能会出现肌肉痉挛、烦躁不安，从而影响睡眠。多项研究都指出，较高的膳食镁摄入量与更好的睡眠质量、更长的睡眠时间以及减少日间功能障碍有关 4447484950。你可以通过多吃绿叶蔬菜（如菠菜、羽衣甘蓝）、坚果（杏仁、腰果）、全谷物（糙米、燕麦）和豆类来补充镁。
当然，除了多吃“助眠食物”，我们更要学会避免那些“醒神食物”，尤其是咖啡因和酒精。
咖啡因是很多人早上提神醒脑的“续命水”，但如果在下午或晚上摄入过多，它就会变成睡眠的“拦路虎”。咖啡因是一种兴奋剂，会阻碍腺苷（一种促进睡眠的化学物质）的作用，让你保持清醒 445152。所以，如果你有睡眠困扰，建议在睡前6小时，甚至更早，就停止摄入咖啡因，包括咖啡、浓茶、巧克力和一些能量饮料。
酒精虽然一开始可能会让你感到放松甚至困倦，但它实际上是一个“伪装者”，它会严重扰乱你的睡眠结构 4451。酒精代谢后会影响你的睡眠周期，尤其是减少深睡眠和快速眼动睡眠的时间，并增加夜间醒来的次数，让你第二天醒来感觉更疲惫，而不是神清气爽 51。一项针对金融交易员的研究发现，酒精摄入会显著降低主观睡眠质量，而咖啡因摄入则会导致睡眠时间缩短 51。所以，为了优质的睡眠，尽量避免在睡前饮酒。
总之，健康的饮食模式，比如富含水果、蔬菜、全谷物、健康脂肪和瘦肉蛋白的膳食，不仅对整体健康有益，也与更好的睡眠质量息息相关 49505354。一项研究甚至指出，较高的水果和蔬菜摄入量能够预测更少的夜间睡眠中断 50。所以，从今天起，让我们从“吃”开始，为好睡眠打下坚实的基础。
3.2 动对方式：力量训练比有氧更助眠？
除了“吃”得对，我们还需要“动”得对。适度的运动对改善睡眠有显著益处，但不同的运动方式对睡眠的影响可能有所不同。你可能觉得只要运动了就能睡得好，但事实可能比你想象的更精细。
长期以来，有氧运动（比如跑步、游泳、快走）被认为是改善睡眠的“金标准”。确实，有氧运动可以促进身体放松，缓解压力，帮助我们更快入睡。然而，最新的研究却给我们带来了一些新的视角，那就是力量训练，这种通常被认为是“塑形增肌”的运动，在改善睡眠方面可能比单纯的有氧运动更胜一筹 55。
一项针对老年人的系统回顾和网络荟萃分析就指出，在提升老年人睡眠质量方面，结合肌肉耐力训练的步行运动（可以理解为带有力量训练元素的运动，比如负重步行或简单的抗阻训练）比单纯的步行、普拉提、甚至太极等都有更好的效果 56。另一项针对睡眠质量差的老年人的研究也发现，力量训练可以显著改善他们的主观睡眠质量，包括减少入睡时间、提高睡眠效率、减少夜间觉醒等 5758。甚至有研究直接得出结论，针对肌肉的力量训练，相比有氧运动或两者结合，是改善睡眠质量最有效的方式 59。
这是为什么呢？力量训练，例如举哑铃、使用弹力带，或是进行自重训练（如深蹲、俯卧撑），能够：
- 增加身体的疲劳感：力量训练会给肌肉带来一定的刺激和微损伤，身体在修复过程中会消耗能量，从而产生生理性的疲劳感，这有助于我们更快地进入深度睡眠。
- 缓解焦虑和抑郁：力量训练被证明对改善焦虑和抑郁情绪有积极作用 55，而情绪问题往往是睡眠障碍的重要原因。
- 改善身体组成：力量训练有助于增加肌肉量，降低体脂率。前文提到，肥胖，特别是与阻塞性睡眠呼吸暂停相关的肥胖，是睡眠的一大杀手。结合有氧和力量训练的综合运动方案，有助于改善阻塞性睡眠呼吸暂停患者的睡眠质量，进而改善整体健康状况 60。
那么，我们应该怎么“动”才能更好地助眠呢？建议你尝试将力量训练纳入你的日常锻炼计划。不需要去健身房举重，简单的居家训练也能达到效果。例如，每周进行3次，每次持续30分钟的力量训练。你可以选择：
- 自重训练：深蹲、弓步、俯卧撑、卷腹等。
- 哑铃或弹力带训练：选择适合自己力量的轻量哑铃或弹力带，进行二头肌弯举、肩部推举、划船等动作。
重要的是要持之以恒。另外，运动时间也很关键。有研究表明，运动对睡眠有益，但睡前进行高强度运动可能会导致兴奋，影响入睡，因此建议将力量训练安排在白天或傍晚进行，睡前2-3小时内避免剧烈运动 61。对于一些特殊群体，比如女举重运动员，即使在赛前减重期间，个性化的营养补充也能显著改善她们的疲劳和睡眠质量 62。而对于普通人来说，坚持力量训练，搭配均衡饮食，就能为你的睡眠打下坚实的基础。
3.3 睡前1小时：从“刷手机”到“放松仪式”的转换
现在我们来到了最关键的“临门一脚”——睡前的一小时。很多人习惯在这个时候刷手机、看电视，殊不知这恰恰是把睡意“赶跑”的罪魁祸首。为了让大脑和身体顺利从白天的兴奋模式切换到睡眠模式，我们需要为自己量身定制一套“睡前放松仪式”。这就像是给身体发出一个明确的信号：“好了，是时候放松下来，准备睡觉了。”
首先，告别蓝光，拥抱暖光。前面我们已经提到，电子产品屏幕发出的蓝光会抑制褪黑素的分泌，干扰我们的生物钟 27。所以，睡前一小时，请你勇敢地放下手机、平板和电脑，也避免看电视。取而代之的是，把房间里的主灯调暗，或者只开一盏柔和的暖光台灯。暖黄色的灯光能让大脑接收到“天色已晚”的信号，有助于为入睡做好准备。如果你家有智能灯具，不妨设置一个“睡眠模式”，让灯光在睡前自动调暗并切换到暖色调。即使在医院这样嘈杂的环境中，通过改善光线和控制噪音等措施，也有助于提升患者的体验和满意度 63。
其次，用阅读点亮你的睡前时光，而非屏幕。放下手机，你会发现睡前多了很多宝贵的时间。这时候，拿起一本你喜欢的纸质书，沉浸在文字的世界里，是一个非常好的选择。阅读纸质书不仅能让眼睛得到放松，避免蓝光刺激，还能帮助大脑从日常的烦恼中抽离出来，进入一种平静专注的状态。一项针对青少年的研究显示，睡前阅读纸质书的青少年，相比于睡前使用电子设备的青少年，拥有更长的睡眠时间、更好的睡眠质量和更高的睡眠效率 64。所以，把你的电子设备请出卧室，让纸质书成为你睡前的最佳伴侣吧。
接着，我们来点实际的“放松练习”。你可以尝试渐进式肌肉放松（Progressive Muscle Relaxation, PMR）。这是一种通过有意识地绷紧身体某一块肌肉，然后彻底放松，来感知和学习放松身体的方法。你只需要花10分钟，从脚趾开始，依次绷紧再放松身体的各个部位，感受肌肉从紧张到松弛的变化。比如，先用力绷紧脚趾，数五秒，然后彻底放松，感受脚趾的松软。接着转移到小腿、大腿、腹部、手臂、肩膀、颈部，最后到面部。这个过程不仅能帮助你缓解身体的紧张感，也能让你的大脑专注于当下，不再胡思乱想。研究表明，渐进式肌肉放松训练能有效改善癌症患者的睡眠质量，并减轻他们的焦虑和抑郁 65。对于慢性紧张性头痛患者，这种方法也显著降低了疼痛和残疾，并提升了睡眠质量 66。
最后，如果环境允许，你还可以尝试一些小工具来进一步提升睡眠质量。例如，眼罩和轻柔的音乐。眼罩能有效隔绝光线，为眼睛创造一个完全黑暗的环境，这对于褪黑素的分泌至关重要。而选择一些轻柔、舒缓的纯音乐或白噪音，能帮助你屏蔽外界的嘈杂，让大脑更快地进入放松状态。有临床研究发现，对于重症监护室（ICU）的病人来说，每晚佩戴眼罩并听1小时的舒缓古典音乐，能显著提高他们的睡眠质量，甚至降低术后谵妄（一种精神错乱状态）的发生率 6768。这足以说明，眼罩和音乐即使在极度不利于睡眠的环境中，也能发挥强大的助眠作用。当然，并非所有音乐都适合助眠，最好选择没有歌词、节奏缓慢、音量适中的音乐。
总之，睡前的一小时是为你的身体和大脑创造最佳睡眠环境的关键时刻。从“刷手机”的习惯中解脱出来，用调暗灯光、阅读纸质书、渐进式肌肉放松以及眼罩加音乐等一系列“放松仪式”，来引导自己平稳地进入梦乡。这些看似简单的改变，正是通往高质量睡眠的康庄大道 6970。
4. 环境优化：打造“零干扰”睡眠空间
你的卧室不仅仅是你睡觉的地方，它更应该是你身体和心灵的“充电站”。一个好的睡眠环境，就像是一个安静、舒适、没有干扰的港湾，能让你卸下白天的疲惫，安心地进入深度睡眠。所以，除了调整自身的习惯，打造一个“零干扰”的睡眠空间也同样重要。
4.1 温度与湿度：18-22℃的黄金睡眠温度
你有没有发现，在太热或太冷的房间里，总是翻来覆去睡不着？这可不是你的错觉。我们的大脑和身体，其实都有一套精密的“温度调节系统”，它在睡眠过程中扮演着非常关键的角色。
体温下降与入睡的关系：
想要顺利进入梦乡，身体需要做的第一件事就是“降温”。在晚上，我们身体的核心温度会自然地开始下降，这个温度下降的过程，正是给大脑发出“该睡觉了”的信号 7172。你可以把它想象成给一个高速运转的机器降温，只有温度降下来，机器才能进入待机或休眠模式。如果卧室温度过高，身体为了散热，反而会保持活跃状态，让你难以入睡。反之，如果温度过低，身体会感到寒冷，同样会消耗能量来维持体温，让你无法放松下来。
那么，究竟多少度才是“黄金睡眠温度”呢？一般来说，18-22摄氏度被认为是大多数人感觉最舒适的睡眠温度区间。在这个温度范围内，我们的身体无需额外费力去散热或保暖，可以更轻松地完成体温下降的准备工作，从而更快地进入深度睡眠。如果房间温度过高，不仅会影响睡眠效率，甚至还会降低睡眠质量 73。
透气床品的选择：
除了空调或暖气，选择合适的床品也能帮助你维持一个舒适的睡眠温度。推荐使用透气性好、吸湿性强的材质，比如纯棉或亚麻的床单、被套和睡衣。这些天然纤维能够有效地带走身体散发的热量和汗水，保持皮肤干爽，让你在整个夜晚都能维持在一个舒适的微气候环境中。相比之下，一些合成纤维（如涤纶）可能会阻碍透气，导致身体闷热，从而影响睡眠。有研究表明，不同的纤维材料对睡眠质量的影响复杂，但像鹅绒被能在较冷环境下增加慢波睡眠，羊毛睡衣则有助于成年人在不同温度下更快入睡 74。
湿度的控制：
除了温度，湿度也是一个常常被我们忽视，但对睡眠质量有重要影响的因素。空气湿度过高，会让人感觉闷热黏腻，出汗后不易蒸发，影响散热；湿度过低则可能导致皮肤干燥、口鼻不适，甚至引起呼吸道刺激。虽然理想的卧室湿度没有一个绝对的定论，但通常建议控制在适宜的范围内，例如40%-60%之间。有研究将30%-50%的相对湿度定义为适宜范围，并探讨了极端湿度条件对健康的影响 75。
你可以通过以下几种方法来控制卧室湿度：
- 湿度过高：在潮湿的季节或地区，可以使用除湿机来降低室内湿度。
- 湿度过低：在干燥的季节或北方地区，可以使用加湿器来增加空气湿度。但要注意定期清洁加湿器，避免细菌滋生。
- 保持通风：适当的通风有助于室内空气流通，调节温度和湿度。
有研究发现，卧室环境中的湿度虽然不一定直接影响客观睡眠效率，但与主观的睡意和睡眠质量相关 73。而过低的室内湿度，例如空调环境下的湿度降低，甚至可能对肾功能产生轻微影响 76。这提醒我们，保持一个适宜的湿度环境，不仅仅是为了睡得舒服，也是为了整体健康。
所以，想要睡个好觉，别忘了关注你的卧室温度和湿度，给身体创造一个最佳的“睡眠小气候”。
4.2 光线与噪音：遮光帘+白噪音的组合方案
想象一下，你正准备进入甜美的梦乡，突然一道刺眼的光线透过窗帘射进来，或者窗外传来汽车的鸣笛声，是不是瞬间睡意全无？没错，光线和噪音是睡眠环境中的两大“捣蛋鬼”，它们会毫不留情地打断我们的睡眠。
光线：睡眠的“隐形杀手”
我们的身体里有一个非常重要的“时间管理者”，它就是前面提到过的昼夜节律（生物钟）。这个生物钟对光线非常敏感，特别是蓝光 27。当眼睛接收到蓝光时，它会给大脑发送信号，告诉大脑“现在是白天，保持清醒”，同时抑制褪黑素（一种帮助我们入睡的激素）的分泌 28。
这意味着，即使是很微弱的光线，尤其是有蓝光成分的光线，在夜间也可能干扰我们的睡眠。比如，卧室里电视机的待机指示灯，或者窗外路灯的光线，都可能在不知不觉中影响你的睡眠质量，让你更难入睡，或者睡眠深度不够 7778。有研究显示，夜间暴露在人造光下会显著扰乱生物钟，并增加患2型糖尿病的风险 79。一项在波兰进行的调查也显示，有41.4%的受访者使用遮光帘来减少夜间光线暴露 80。
所以，想要拥有一个黑甜的睡眠，第一步就是要隔绝光线。
- 遮光帘：这是最简单也最有效的解决方案之一。遮光帘（Blackout Curtains）常被用于减少进入房间的光线，营造一个更适宜睡眠的环境 81。选择深色、厚重的材质，确保窗帘能完全覆盖窗户边缘，不留缝隙。
- 眼罩：如果你觉得遮光帘不够完美，或者在旅行、午休等场合，眼罩是你的绝佳伴侣。它能直接阻挡进入眼睛的光线，效果立竿见影。临床研究显示，在医院环境下，给患者佩戴眼罩等工具能显著改善疲劳评分，同时在睡眠相关的一些其他指标上也呈现出改善趋势 82。
噪音：甜蜜梦乡的“破坏者”
你是否经历过被突如其来的噪音惊醒，然后翻来覆去再也睡不着的情况？即使没有被惊醒，持续的低频噪音也会让大脑处于警觉状态，影响睡眠的深度和连续性。噪音就像一个“隐形”的干扰源，它会增加夜间觉醒的次数，缩短深睡眠的时间，让你第二天感到疲惫不堪。
在城市环境中，交通噪音、邻居的吵闹声、甚至是家电发出的嗡嗡声，都可能是睡眠的“杀手”。那么，我们应该如何应对噪音呢？
- 耳塞：简单有效的物理隔音工具。选择适合自己耳道的耳塞，能显著降低环境噪音。
- 白噪音：这是一种特殊的、听起来像“沙沙声”的噪音，它包含所有频率的声音，并以相同的强度呈现。白噪音的奇妙之处在于，它可以“掩盖”其他突发的、不规则的噪音。想象一下，如果房间里一直有轻柔的沙沙声，突然一声门响，你的大脑可能就不那么容易注意到它了，因为它被白噪音“抹平”了。
多项研究表明，白噪音在改善睡眠方面具有潜力。例如，一项针对纽约市居民的研究发现，在噪音环境下，白噪音显著改善了受试者的睡眠，包括减少了夜间觉醒时间和入睡时间 83。在住院环境中，白噪音也能有效提高患者的睡眠效率，且耐受性良好 84。
然而，在使用白噪音时，也需要注意一些事项。不是所有人都适合白噪音，也不是所有白噪音设备都能随意使用。一些研究指出，白噪音的有效性证据仍然很低 8586，甚至长时间、高强度的白噪音暴露可能对儿童听力发育产生负面影响 87。因此，如果你选择使用白噪音，请务必注意：
- 音量适中：音量不宜过高，应以能掩盖其他噪音，但不至于干扰自己入睡为宜。
- 非持续性使用：最好不要整夜都开着白噪音，可以在入睡前使用一段时间，待进入深睡眠后再关闭。
- 选择合适的设备：市面上有专门的白噪音机器或APP，可以尝试选择柔和、自然的白噪音（如雨声、海浪声），避免刺耳的噪音。
总而言之，打造一个黑暗、安静的睡眠环境，是高质量睡眠的基石。拉上遮光帘，戴上耳塞，或者让轻柔的白噪音陪伴你入睡，这些小小的改变，都能为你的睡眠带来大大的不同。
5. 心理干预：从焦虑到平静的“认知重塑”
前面我们探讨了生理和环境因素对睡眠的影响，但别忘了，我们的“内心戏”——也就是心理和情绪，在睡眠这场大戏中也扮演着举足轻重的角色。有时候，失眠并不是身体的毛病，而是大脑“想太多”了。当你躺在床上，脑子里还在上演各种“大片”，焦虑、担忧、烦躁如影随形时，想睡个好觉简直比登天还难。
这时候，就需要“心理干预”这种专业的帮手了。它不是让你吃药，而是通过一系列科学的方法，帮助你重新认识睡眠，改变那些不利于睡眠的思维模式和行为习惯。这就像给你的大脑做一次“认知重塑”，让它学会如何从焦虑的状态回归平静，最终实现安然入睡。
5.1 CBT-I：失眠认知行为疗法的核心技巧
在众多心理干预方法中，失眠认知行为疗法（Cognitive Behavioral Therapy for Insomnia, CBT-I）被认为是治疗慢性失眠的“黄金标准”，甚至比药物治疗的效果更持久 888990。CBT-I不是简单地教你几招放松技巧，而是一套系统的、经过科学验证的治疗方案，它主要针对那些导致或维持失眠的认知（想法）和行为（习惯）。
CBT-I的核心思想是：失眠往往是因为我们对睡眠产生了错误的认知（比如“我如果今天睡不好，明天肯定会搞砸一切”）和不健康的睡眠行为（比如“躺在床上玩手机，希望玩累了就睡着了”）。CBT-I会一步步地纠正这些“错误”，让你重新建立健康的睡眠模式。它包含几个关键组成部分 9192：认知疗法、刺激控制、睡眠限制、睡眠卫生教育以及放松训练。其中，“刺激控制”和“睡眠限制”是两大核心技巧，它们就像两把钥匙，能帮助你打开好睡眠的大门。
刺激控制（Stimulus Control）：
这个技巧听起来有点专业，但原理很简单：只在困倦时才上床，并且把床和卧室严格限定为“睡觉”和“亲密行为”的专属区域，切断其他活动与床铺的联系。想象一下，如果你的床铺变成了办公室、餐厅、电影院，甚至是个小型娱乐中心，你还在上面办公、吃饭、刷剧、打游戏，那么你的大脑就会把床和“清醒”甚至“兴奋”联系起来。长此以往，等你真的想睡觉时，大脑反而会发出“警醒”的信号，让你难以入睡。
刺激控制疗法要求你：
- 只在感到困倦时才上床睡觉：如果还不困，就不要躺在床上。
- 如果躺在床上20分钟仍无法入睡，就立刻起床：离开卧室，做一些轻松不刺激的事情，比如阅读纸质书（避免蓝光），听轻柔的音乐，直到再次感到困倦时再回到床上。重复这个过程，直到你睡着。
- 无论前一晚睡得如何，每天都要在固定的时间起床：这有助于稳定你的生物钟。
- 白天避免小睡：如果非要小睡，也要控制在20-30分钟以内，避免在下午晚些时候小睡。
- 将床和卧室仅用于睡眠和亲密行为：不要在床上看电视、玩手机、吃饭、工作或思考烦心事。
通过这种方式，你的大脑会重新建立起“床=睡觉”的条件反射，让床成为一个强烈的睡眠提示，从而更快地进入睡眠状态。
睡眠限制（Sleep Restriction）：
这个技巧听起来可能有点反直觉，因为它要求你暂时缩短卧床时间。但别担心，这是一种有策略的“先苦后甜”。很多失眠患者为了“补觉”，往往会延长卧床时间，希望能在床上多躺一会儿就能多睡一会儿。但结果往往适得其反，长时间躺在床上却睡不着，反而会增加焦虑感，降低睡眠效率。睡眠限制疗法正是要打破这个恶性循环。
它的核心做法是：
- 根据你目前实际的平均睡眠时间来设定卧床时间：比如，你每天在床上躺8小时，但实际只睡了5小时。那么在治疗初期，CBT-I可能会建议你每天只卧床5.5小时。
- 在设定的卧床时间内，你必须努力保持睡眠：由于卧床时间缩短了，你会更容易感到疲倦，从而提高睡眠效率。
- 当你的睡眠效率达到一定标准（比如85%以上）时，再逐渐增加卧床时间：每次增加15-30分钟，直到达到你所需的总睡眠时间，同时保持高效率的睡眠。
睡眠限制的目的是人为地制造轻度睡眠不足，从而增加睡眠驱动力，提高睡眠的连续性和深度，最终改善睡眠质量。多项研究表明，睡眠限制是CBT-I中非常有效的组成部分 9193。它被广泛应用于成人慢性失眠的治疗，甚至对于学龄儿童和青少年，结合睡眠限制的CBT-I也显示出有益的效果 94。
线上CBT-I的可行性：
你可能会想，这些专业的疗法是不是很难接触到？好消息是，随着科技的发展，线上（eHealth或app-based）的CBT-I已经变得越来越普及和有效。
许多研究证实，通过智能手机应用程序或在线平台提供的CBT-I，与传统的面对面CBT-I一样，能够显著改善失眠症状，提高睡眠质量，并降低伴随的抑郁和焦虑症状 959697。例如，一项针对中国人群的随机临床试验表明，与单纯的睡眠教育相比，基于智能手机应用程序的中国文化适应性数字CBT-I显著改善了失眠严重程度，提高了总睡眠时间和睡眠效率 98。甚至对于特殊人群，如怀孕女性，数字CBT-I也被证明是一种安全有效的干预措施，能有效改善妊娠期失眠症状 99。
这意味着，即使你无法方便地找到线下心理医生，也可以通过这些数字化工具获得专业的失眠治疗。当然，在使用这些线上工具时，最好选择那些经过临床验证、由专业团队开发的产品，并遵循其指导进行。
5.2 正念与冥想：用“身体扫描”告别“大脑停不下来”
你是不是经常在夜深人静时，发现大脑像一台停不下来的机器，各种思绪、担忧、计划，甚至一些无关紧要的片段在脑海中反复播放，让你难以入睡？这种“大脑停不下来”的状态，在心理学上被称为反刍思维（rumination），它是失眠和焦虑的常见“帮凶” 100。而正念（Mindfulness）与冥想，正是帮助我们告别这种状态，让身心回归平静的强大工具。
正念，简单来说，就是有意识地、不加评判地关注当下。它不是要你清空大脑，而是要你学会观察自己的思想、情绪和身体感受，而不被它们卷入其中。这就像是你在河岸边观察河水流淌，而不是跳进河里被水流冲走。当你的大脑习惯了这种观察模式，它就不会再被那些“跑火车”的思绪所困扰，自然更容易放松下来，进入睡眠状态 101。
冥想是实践正念的一种方式，它有多种形式，其中一种非常适合睡前练习的，就是“身体扫描”（Body Scan）。
5.2.1 身体扫描练习步骤详解
“身体扫描”是一种引导式的冥想练习，它通过将注意力系统地带到身体的各个部位，帮助我们感知身体的细微感受，从而将心绪从外部的烦恼和内在的思绪中拉回当下，回归身体 102。
以下是你可以尝试的“身体扫描”练习步骤：
准备姿势：
- 找一个安静、舒适的地方。你可以躺在床上，也可以坐在椅子上。如果躺着，请确保身体放松，双手放在身体两侧，掌心向上或向下，双脚自然分开。如果坐着，双脚平放在地面上，双手放在膝盖上，背部挺直但不要僵硬。
- 轻轻闭上眼睛，或者将视线柔和地投向前方一米处。
深呼吸，放松身心：
- 先做几个缓慢而深沉的呼吸。用鼻子深深吸气，感受空气充满胸腔和腹部；然后用嘴巴或鼻子缓慢呼气，感受身体的放松。
- 每次呼气时，想象你的身体正在逐渐放松，释放掉一天的紧张和压力。
从脚趾开始，逐一扫描：
- 将你的注意力带到你的脚趾。不需要做任何动作，只是去感受它们。它们是温暖的？冰冷的？麻木的？还是有轻微的刺痛感？只是观察，不加评判。
- 保持注意力在脚趾处约10-20秒，然后随着一次呼气，轻轻地放开对脚趾的关注。
向上移动，感受全身：
- 现在，将注意力缓慢地从脚趾移动到脚底、脚踝、小腿、膝盖、大腿。
- 在每一个身体部位停留片刻，感受那里的感觉。是紧张？酸痛？还是放松？如果发现任何紧张，尝试在呼气时让该部位放松下来。
- 然后，继续将注意力向上移动到臀部、下腹部、上腹部和胸部。感受呼吸时腹部和胸部的起伏。
- 接着，将注意力带到手指、手掌、手腕、前臂、肘部、上臂和肩膀。感受手臂的重量，尝试放松肩膀，让它们下沉。
- 再向上移动到颈部和喉咙。
- 最后，将注意力带到面部：下巴、嘴唇、脸颊、鼻子、眼睛、额头。感受面部肌肉的放松，尤其是下颌骨，让它自然下垂。
感受全身，结束练习：
- 当你的注意力扫描完所有身体部位后，花一些时间整体感受你的身体。
- 感受身体与床或椅子接触的部分，感受重力的作用。
- 当准备好时，轻轻睁开眼睛，或者将视线慢慢抬起，带着一份平静和觉知回到当下。
整个“身体扫描”过程通常持续10-20分钟，你可以根据自己的时间和感受进行调整。如果你的思绪在中途飘走，没关系，这很正常。只是温柔地将注意力再带回到你正在扫描的身体部位即可。
5.2.2 正念与冥想的助眠作用
多项研究表明，正念和冥想，特别是“身体扫描”等练习，对改善睡眠质量和缓解失眠有着显著的效果：
- 减少反刍思维：正念的核心就是学会不评判地观察思绪。对于那些因为“大脑停不下来”而失眠的人来说，正念可以帮助他们减少夜间认知觉醒和“睡前努力”（sleep effort，指为了入睡而进行的努力，反而适得其反） 103。当大脑不再过度思考和担忧时，入睡自然变得更容易。一项针对青少年的研究发现，即使是天生的正念特质，也能有效缓冲反刍思维对睡眠问题的负面影响 100。
- 改善睡眠质量：一项针对患有中度睡眠障碍老年人的随机临床试验发现，与传统的睡眠卫生教育相比，为期6周的正念认知疗法（MAPs）显著改善了他们的睡眠质量，并减少了失眠症状、抑郁症状和疲劳感 104。另一项系统回顾和荟萃分析也指出，正念冥想干预能显著改善睡眠质量，特别是与非特异性活性对照组（如时间匹配的安慰剂干预）相比 105。
- 缓解焦虑和抑郁：失眠常常与焦虑和抑郁等情绪问题并存。正念干预，包括冥想，已被证明能够有效缓解这些精神健康问题 106。一项研究发现，通过冥想App来改善睡眠障碍的成年人，其抑郁和焦虑症状也得到了改善，这主要是因为冥想减少了睡前躯体和认知上的觉醒 107。
- 适用于特殊人群：正念疗法对于各种人群都有益处，例如，在怀孕期间，正念可以作为一种保护因素，对抗夜间反刍思维带来的失眠和抑郁症状 108109。对于老年失眠患者，结合正念和认知疗法的治疗方法被证明是有效的 110。甚至对于癌症患者的非正式家庭照顾者，正念减压（MBSR）训练也能显著降低他们的焦虑水平，改善睡眠质量 111。
总而言之，正念与冥想，尤其是“身体扫描”练习，为我们提供了一个无需药物、成本低廉且副作用小的助眠方法。通过持续的练习，你将学会如何平静自己的心绪，告别那些夜间的“大脑余震”，从而拥抱更深沉、更宁静的睡眠。
6. 科技与医疗：当自我调整不够时的专业方案
当我们尝试了各种日常调整和心理干预，但睡眠问题依然挥之不去时，或许是时候考虑寻求一些专业的科技辅助或医疗介入了。现代科技的发展，为我们提供了更多了解和改善睡眠的工具；而专业的医疗方案，则能针对更复杂的睡眠障碍提供精准的治疗。
6.1 可穿戴设备：看懂睡眠数据的“体检报告”
如今，几乎人手一个的智能手环、智能手表，或者各种智能戒指、睡眠垫等，都在宣称能够监测我们的睡眠。这些可穿戴设备（Wearable Devices）就像我们的“贴身医生”，记录着我们夜晚的一举一动，并生成一份份看似专业的“睡眠报告”。但这些数据到底准不准确？我们又该如何正确解读这些“体检报告”来指导自己的睡眠呢？
6.1.1 它们是怎么工作的？
大多数可穿戴设备通过内置的加速度计（accelerometer）和心率传感器（heart rate sensor）来监测睡眠。加速度计记录身体的微小运动，比如翻身、肢体活动，以此来判断你是清醒、浅睡还是深睡。心率传感器则通过测量心率变化，结合睡眠时心率通常会降低的生理特点，来辅助判断睡眠状态。有些更高级的设备还会集成血氧饱和度传感器，监测夜间的血氧变化，这对于筛查潜在的睡眠呼吸暂停等问题有一定的帮助 112。
这些设备会根据收集到的数据，运用各自专有的算法（通常是商业秘密，不公开细节）来估算你的总睡眠时长、入睡时间、夜间清醒次数，甚至还能“分辨”出浅睡、深睡和快速眼动（REM）睡眠的时长 113114。
6.1.2 它们的“体检报告”到底有多准？
要回答这个问题，我们首先要明确一个“金标准”——多导睡眠图（Polysomnography, PSG）。PSG是目前公认的睡眠监测“金标准”，它需要在睡眠实验室里进行，通过同时记录脑电图（EEG）、眼电图（EOG）、肌电图（EMG）以及呼吸、心率、血氧等多个生理指标，来精确判断睡眠阶段和睡眠障碍 113115116117。
与PSG相比，目前市面上的可穿戴设备在监测睡眠总时长、入睡时间、夜间清醒时长等指标上，表现出了一定的准确性，尤其是一些较新的设备，其表现甚至能超过传统的腕式活动记录仪 116118。例如，有研究对11种主流可穿戴设备进行评估，发现一些设备在唤醒阶段和快速眼动睡眠阶段的表现良好，而另一些则在深睡眠阶段表现优异 115。还有研究发现，Fitbit Charge 4 在总睡眠时间、觉醒后清醒时间和入睡时间方面，与PSG评估结果无显著差异 119。
然而，在精确区分睡眠阶段（特别是浅睡、深睡和REM睡眠）方面，可穿戴设备的准确性仍然有待提高，并且不同设备的表现差异很大 113115116117119。多数可穿戴设备往往倾向于低估睡眠中断、高估总睡眠时间和睡眠效率 114。这意味着，你的手环可能告诉你睡了8小时，但实际上你可能中间醒来很多次，深度睡眠不足。例如，一项元分析结果显示，腕式可穿戴设备在总睡眠时间、睡眠效率、睡眠潜伏期和觉醒后清醒时间等关键睡眠参数的测量上，与PSG存在显著差异 120。Fitbit Charge 4 在深睡眠阶段的评估上显著低估，而在浅睡眠阶段上显著高估 119。
此外，这些设备的准确性还会受到一些因素的影响，比如个体差异（如肤色、身体质量指数BMI）、设备佩戴方式、固件更新以及专有算法等 113116。对于患有睡眠障碍（如失眠症、睡眠呼吸暂停）的人群，可穿戴设备的准确性可能还会进一步下降 119121。例如，一项荟萃分析发现，基于血氧测量的设备在诊断阻塞性睡眠呼吸暂停方面具有很高的敏感性（97%），但在特异性方面较低（63%），这意味着它们在排除疾病方面表现良好，但在确诊上仍需PSG的验证 122。
因此，我们可以把可穿戴设备理解为一种趋势追踪工具，而不是精确的诊断工具。它们在长期监测个人睡眠模式变化方面具有很大潜力，能够帮助我们发现睡眠趋势、评估干预措施的效果，并增加我们对自身睡眠的意识 112116123124。
6.1.3 如何看懂你的“睡眠报告”并调整策略？
虽然可穿戴设备的绝对准确性可能不如PSG，但它们提供的数据依然非常有价值，关键在于你如何正确解读和利用它：
- 关注趋势，而非绝对数值：不要过分纠结于某一天报告的深睡时间是1小时还是1小时10分钟。更重要的是观察长期趋势：你的平均睡眠时长有没有增加？入睡时间有没有缩短？夜间清醒次数是不是变少了？这些趋势性的变化才能真正反映你的睡眠改善情况。
- 对照核心指标，寻找问题：回想我们第一部分讲到的睡眠效率、睡眠潜伏期、觉醒后清醒时间这些核心指标。对照可穿戴设备给出的数据，看看你哪个指标亮了“红灯”。
- 睡眠潜伏期过长（入睡困难）：如果你总要躺很久才能睡着，可能需要加强睡前放松，如进行“身体扫描”冥想，或者调整睡前习惯，避免蓝光刺激。
- 觉醒后清醒时间过长（夜间易醒）：如果报告显示你夜间频繁醒来，或者醒来时间很长，可能需要检查卧室环境（光线、噪音、温度），或者关注是否有生理上的问题（如睡眠呼吸暂停，如果设备有血氧监测功能，可以留意夜间血氧下降情况）。
- 深睡或REM睡眠不足：虽然设备估算不完全准确，但如果长期报告这些睡眠阶段严重不足，可能提示睡眠结构紊乱，需要进一步调整生活习惯，甚至寻求专业评估。
- 结合主观感受，评估干预效果：可穿戴设备的数据是客观参考，但最重要的还是你自己的主观感受。如果你佩戴设备一段时间后，数据有所改善，同时你白天也感觉精神更好了，疲惫感减轻了，注意力更集中了，那么恭喜你，你的睡眠改善策略是有效的！
- 作为自我管理的辅助工具：可穿戴设备可以作为一种自我监控工具，增加你对自身睡眠行为的认识。例如，通过它记录的数据，你可以更清楚地知道哪种睡前活动（比如睡前阅读vs.睡前刷手机）对你的睡眠影响更大，从而帮助你做出更明智的选择 123125126。
- 何时寻求专业帮助？：如果你的可穿戴设备数据显示，尽管你已经尝试了各种调整，睡眠指标依然持续不佳，并且你的白天功能受到严重影响（如白天嗜睡、注意力不集中、情绪低落），那么就应该考虑咨询专业的医生。他们可以根据你的详细情况，进行更专业的诊断，并制定个性化的治疗方案。值得一提的是，有些研究发现，将可穿戴设备的反馈与专业的指导相结合，对于改善失眠症状有积极作用 127。
总之，可穿戴设备是把双刃剑。它能帮你了解睡眠，但不能完全替代专业的医疗诊断。聪明地利用这些工具，结合专业的建议，才能更好地掌控你的睡眠健康。
6.2 药物与补充剂：按需使用的“最后防线”
当你尝试了所有非药物的方法，但失眠的困扰依然严重，甚至影响到白天的生活和工作时，医生可能会建议你考虑使用药物或补充剂。但这绝不是首选方案，而是我们改善睡眠的“最后防线”，并且必须在医生的指导下，按需使用。药物治疗的目的是帮助你在短期内打破失眠的恶性循环，获得喘息的机会，同时为非药物疗法（如CBT-I）的生效争取时间。
这里我们主要讨论几种常见的、可能用于改善睡眠的药物和补充剂，并强调它们各自的适用场景和注意事项：
褪黑素（Melatonin）：重置生物钟的“时间使者”
- 它是什么？ 褪黑素是我们大脑中的松果体在黑暗中分泌的一种天然激素，它的主要作用是调节我们的昼夜节律（生物钟），告诉身体“该睡觉了” 128。它不像安眠药那样直接“强制”你入睡，而是通过调整生理节律，帮助身体自然地准备睡眠。
- 适用场景：褪黑素最适合用于昼夜节律紊乱引起的睡眠问题，比如：
- 倒时差（Jet Lag）：跨时区旅行时，服用褪黑素可以帮助你更快地适应新的作息时间。
- 轮班工作者（Shift Work Disorder）：经常上夜班或倒班的人，生物钟容易混乱，褪黑素可以帮助他们调整。
- 老年人：随着年龄增长，体内褪黑素分泌会减少，因此补充褪黑素可能对部分老年人的入睡困难有帮助。
- 儿童和青少年：尤其是患有自闭症谱系障碍（ASD）的儿童和青少年，常存在睡眠问题，褪黑素对改善他们的入睡时间有显著益处，且通常耐受性良好 129。
- 注意事项：
- 剂量与时间：通常建议在睡前1-2小时服用小剂量（如0.5-3毫克），具体剂量应遵医嘱。
- 非万能药：褪黑素并非对所有类型的失眠都有效，特别是对于由焦虑、抑郁等心理因素引起的慢性失眠，其效果不如认知行为疗法。美国睡眠医学学会的临床实践指南甚至建议，不应将褪黑素作为成人失眠的常规治疗 130。
- 副作用：虽然通常耐受性良好，但少数人可能出现头晕、恶心、嗜睡等副作用。
- 新兴研究：除了助眠，褪黑素还被发现具有抗氧化、抗炎和免疫调节等多种生理功能 131 132 133 134 135。一些研究正在探索褪黑素在糖尿病及其并发症（如糖尿病心肌病）中的潜在益处，例如发现它能改善糖尿病患者的睡眠质量 136，以及其对糖尿病心肌病的保护作用 137。此外，褪黑素的抗氧化和抗炎特性也被认为可能在糖尿病管理中发挥作用 138。但这些仍处于研究阶段，不能作为自行用药的依据。
米氮平（Mirtazapine）：抗抑郁药中的“助眠者”
Z类药物（Z-drugs）：快速入睡的“催眠曲”
- 它们是什么？ Z类药物包括佐匹克隆（zopiclone）、唑吡坦（zolpidem）、扎来普隆（zaleplon）和艾司佐匹克隆（eszopiclone）等。它们虽然化学结构与苯二氮䓬类药物不同，但作用机制类似，都能快速起效，帮助人们入睡或维持睡眠，因此也被称为“非苯二氮䓬类安眠药”。
- 适用场景：主要用于短期治疗严重影响日常生活的失眠，特别是入睡困难的患者 130。
- 注意事项：
其他药物：
- 苯二氮䓬类药物（Benzodiazepines, BZDs）：如三唑仑（triazolam）、替马西泮（temazepam）等。这类药物历史悠久，效果显著，但因其依赖性、戒断症状和认知功能损害风险，美国睡眠医学学会的指南建议仅在有适应症时谨慎使用，并强调其短期使用的重要性 130 144 145。
- 度洛西汀（Doxepin）：一种三环类抗抑郁药，小剂量时具有镇静作用，可用于改善睡眠维持困难的失眠 130 142。
- 食欲素受体拮抗剂（Orexin Receptor Antagonists）：如舒沃雷生（suvorexant）、来博雷生（lemborexant）。这类新型药物通过阻断食欲素（一种促清醒神经递质）的作用来促进睡眠，被认为具有较好的安全性和有效性，特别是来博雷生在改善总睡眠时间、入睡时间等方面表现优异 142 146。
核心原则：按需使用，避免长期依赖
无论是哪种药物，都应牢记其是辅助手段，而非根本解决方案。药物可以帮助你快速入睡或减少夜间觉醒，但它并不能教会你健康的睡眠习惯，也无法解决失眠背后的心理或生理问题。因此，在使用药物的同时，更重要的是积极配合医生，探究失眠的根本原因，并结合认知行为疗法等非药物干预。
对于药物和补充剂，请务必：
- 咨询专业医生：不要自行诊断、自行用药。
- 严格遵医嘱：包括剂量、服用时间、用药时长。
- 警惕依赖性：许多助眠药物都存在成瘾或依赖的风险，避免长期服用。
- 关注副作用：及时向医生反馈用药后的任何不适。
药物是双刃剑，用得好可以帮助你渡过难关，用不好则可能带来新的麻烦。因此，谨慎和专业指导是使用药物和补充剂改善睡眠的关键。
7. 特殊人群：老年人、更年期、学生的定制方案
睡眠问题并非千篇一律，不同年龄阶段、生理状况的人群，其睡眠障碍的原因和表现也各不相同。因此，针对这些特殊人群，我们需要“量体裁衣”，提供更加个性化、定制化的睡眠改善方案。
7.1 老年人：太极+经颅磁刺激的协同增效
老年人的睡眠，常常伴随着“碎片化”、“入睡难”、“易醒”等特点。这不仅与年龄增长带来的生理变化（如褪黑素分泌减少）有关，还可能受到多种慢性疾病、药物影响以及认知功能下降的困扰。传统的运动和心理干预虽然有效，但老年人往往因为身体状况或依从性问题难以长期坚持。近年来，一些结合传统疗法和现代科技的创新方案，为改善老年人的睡眠和认知功能带来了新的希望。其中，太极拳与经颅磁刺激（rTMS）的协同增效作用，正受到越来越多的关注。
太极拳——动中求静的传统智慧
太极拳作为一种中国传统的健身方式，以其舒缓、连贯的动作和深呼吸的练习，被认为是老年人改善身心健康的理想选择。它不仅能锻炼身体，提高平衡感，还能促进身心放松。多项研究已经证实，太极拳对改善老年人的睡眠质量有积极作用。
- 改善睡眠效率和夜间觉醒：一项针对老年失眠症患者的随机临床试验发现，与常规锻炼组和对照组相比，为期12周的太极拳训练显著提高了老年人的睡眠效率，并减少了觉醒后清醒时间和夜间觉醒次数。这意味着，太极拳能帮助老年人更快入睡，睡得更踏实，夜间醒来的次数也更少 147。
- 非主观报告的客观改善：该研究还特别指出，这些睡眠参数的改善是通过活动记录仪（一种客观测量睡眠的设备）评估得出的，排除了主观报告可能带来的偏差 147。这表明太极拳对睡眠的改善是真实且可测量的。
- 长期效果持续：更令人振奋的是，太极拳带来的这些益处，在24个月的随访期内仍然保持 147。这说明太极拳不仅是短期的“速效药”，更是长期的“养生方”。
- 改善认知功能：除了睡眠，太极拳还能改善老年人的认知功能，特别是对于帕金森病患者，太极拳训练可以显著改善他们的睡眠质量和认知功能 148。甚至对于慢性疲劳综合征患者，太极拳也能通过增强大脑的功能连接，改善疲劳症状和睡眠质量 149。
经颅磁刺激（rTMS）——精准调控大脑的现代科技
经颅磁刺激（rTMS）是一种非侵入性的神经调控技术，它通过线圈产生变化的磁场，穿透颅骨，在大脑皮层产生感应电流，从而调节大脑神经元的活动。近年来，rTMS被广泛应用于治疗抑郁症、焦虑症等精神疾病，同时也展现出改善睡眠障碍的潜力。
- 改善慢性失眠：低频rTMS被认为是一种有前途的慢性失眠治疗方法。研究表明，对大脑特定区域进行低频rTMS治疗，可以显著改善慢性失眠患者的睡眠质量，减少失眠严重程度。更重要的是，这种改善不仅体现在主观感受上，还能促进大脑的淋巴清除功能（Glymphatic function），这是一种在大脑睡眠时清除代谢废物的重要机制，并且与认知功能的改善相关 150。
- 提升认知功能：对于伴有轻度认知障碍（MCI）的老年人，rTMS不仅能改善睡眠，还能提升整体认知功能。一项针对阿尔茨海默病患者的随机对照试验显示，rTMS能有效改善患者的睡眠障碍，并对其认知功能有积极影响 151。
- 帕金森病患者的客观睡眠改善：对于帕金森病患者而言，低频rTMS被发现能显著改善其客观睡眠结构，例如增加快速眼动（REM）睡眠的比例，并提高非REM睡眠期间的低频慢波脑电活动，这与患者运动症状和认知功能的改善相关 152。
太极+rTMS：1+1>2的协同增效
单独使用太极拳或rTMS都能改善老年人的睡眠和认知，那么将两者结合起来，效果会不会更好呢？答案是肯定的。
多项研究正在探索这种“协同增效”的方案：
- 一项随机临床试验发现，对于同时患有睡眠障碍和轻度认知障碍（MCI）的老年人，为期6周的太极拳结合1-Hz rTMS（针对右背外侧前额叶皮层）治疗，相比单纯太极拳或安慰剂rTMS组，能够更显著地降低匹兹堡睡眠质量指数（PSQI）评分（即睡眠质量更好）和提高蒙特利尔认知评估量表（MoCA）评分（即认知功能更好） 153。
- 另一项先驱性研究也证实，对于老年人的睡眠障碍，太极拳结合主动rTMS相比于单纯太极拳、太极拳结合安慰剂rTMS或低强度体育锻炼对照组，能够更显著地缩短入睡时间。在没有抑郁症状的亚组中，联合治疗还能更显著地提高睡眠效率并减少觉醒后清醒时间 154。
- 甚至有试点研究发现，为期4周的太极拳加rTMS组合干预，相比于单独太极拳或常规护理，能更快、更显著地改善老年人的失眠严重程度，并且这种改善在3个月的随访期内仍然维持。研究者推测这种组合治疗可能通过干预不同的觉醒成分来协同缓解睡眠障碍 155。
老年人的定制方案建议：
综合上述研究，对于老年人，尤其是伴有轻度认知障碍或慢性失眠的老年人，以下方案可作为参考：
太极拳练习：
- 频率和时长：建议每周至少5次，每次1小时的太极拳练习。这不仅能锻炼身体，还能平复心绪，为夜晚的睡眠做准备。
- 形式：可以选择简化的24式太极拳，或根据个人身体状况选择更温和的八段锦等传统功法。重要的是动作要舒缓，呼吸要深长。
- 持之以恒：太极拳的效果需要长期坚持才能显现，建议将它融入日常生活中。
经颅磁刺激（rTMS）：
这些定制化方案，充分利用了传统智慧和现代科技的优势，为老年人提供了更全面、更有效的睡眠改善途径。
7.2 更年期女性：非激素药物与正念的双重选择
更年期，是女性生命中一个特殊的生理阶段，它标志着生育能力的终结。然而，这个阶段往往伴随着一系列令人不适的症状，其中最常见、也最让人困扰的之一就是睡眠障碍 156。许多女性在更年期会出现入睡困难、夜间频繁醒来、睡眠质量下降等问题，这严重影响了她们的生活质量和日常功能 157158。
为什么更年期女性的睡眠会受到如此大的挑战呢？这背后有多重原因：
- 激素波动：更年期最显著的变化是卵巢功能衰退，导致雌激素水平大幅波动和下降 156。雌激素在调节睡眠方面扮演着重要角色，它的减少会直接影响睡眠，导致睡眠问题 156。
- 潮热和盗汗（血管舒缩症状，VMS）：这是更年期女性最普遍的症状之一 159。突然袭来的热潮和随之而来的盗汗，常常在夜间发生，会把人从睡梦中惊醒，导致睡眠中断，从而严重影响睡眠质量 156157160。有研究指出，更年期的睡眠问题与潮热的频率和严重程度密切相关 161162。
- 情绪变化：更年期女性更容易出现焦虑、抑郁、烦躁等情绪问题 156163。这些负面情绪本身就是失眠的强大推手，会延长入睡时间，增加夜间觉醒，形成恶性循环。
- 其他因素：年龄增长本身、肥胖、其他睡眠障碍（如阻塞性睡眠呼吸暂停）、褪黑素分泌减少以及昼夜节律改变等，也都会加剧更年期女性的睡眠问题 156164。
面对这些复杂的睡眠挑战，传统的激素替代疗法（MHT）虽然对缓解潮热和相关的睡眠障碍有效 157，但并非所有女性都适合或愿意接受激素治疗 159165。幸运的是，随着医学的进步，我们有了更多的非激素药物选择，同时，结合心理和身心疗法，如正念舞蹈疗法，也能为更年期女性带来双重保障。
7.2.1 非激素药物：Fezolinetant的登场
长期以来，非激素的更年期症状治疗方案在疗效上总是略逊一筹 165。但近年来，一种全新的非激素药物——fezolinetant（非唑奈坦）的出现，为中度至重度血管舒缩症状（VMS）的更年期女性带来了福音，它在改善潮热的同时，也对睡眠障碍产生了积极影响 166167168。
- 作用机制：Fezolinetant的工作原理非常巧妙。在更年期，由于雌激素水平下降，大脑中一种名为神经激肽B（neurokinin B）的物质会过量表达，并作用于大脑下丘脑的神经激肽3受体（NK3R）。这个NK3R被认为是体温调节中心的“开关”，它的过度活跃会导致潮热和盗汗等VMS症状 166168。Fezolinetant正是通过选择性地阻断NK3R，从而精准地抑制了这种过度活跃，帮助体温调节恢复正常 159166。你可以把它想象成给过度兴奋的“体温调节开关”踩了刹车，让它不再乱“跳闸”。
- 疗效与安全性：在多项临床试验中，Fezolinetant被证实能显著降低VMS的频率和严重程度 159166。更令人欣喜的是，这种对潮热的积极作用也转化成了对睡眠障碍的改善 166167。研究显示，使用Fezolinetant的女性，不仅潮热次数减少，睡眠质量也得到了提升，这有助于改善她们与更年期相关的整体生活质量 168169。而且，Fezolinetant作为非激素药物，为那些因健康原因（如乳腺癌史）或个人意愿不适合使用激素疗法的女性，提供了一个安全有效的替代选择 159166。
- 适用人群：Fezolinetant主要适用于中度至重度血管舒缩症状（VMS）的更年期女性，特别是那些不能或不愿使用激素替代疗法的女性 166。它代表了更年期治疗领域的“创新”，填补了长期以来的治疗空白 166。
7.2.2 正念舞蹈疗法：身心合一的助眠艺术
除了药物，将身心疗法融入日常，也能为更年期女性的睡眠带来意想不到的积极效果。在各类身心疗法中，正念舞蹈疗法作为一种富有表现力的艺术形式，正日益受到关注 170。
- 正念舞蹈疗法：它将正念（即有意识地关注当下，不加评判）的理念融入到舞蹈和身体动作中。通过引导参与者专注于身体的感受、呼吸和动作本身，而不是去评判动作的优美与否，它可以帮助更年期女性释放身心压力，缓解焦虑，改善情绪，并最终促进睡眠 170。
- 疗效数据：一项对随机对照试验的系统回顾和荟萃分析显示，包括正念舞蹈疗法在内的身心疗法，对更年期女性的睡眠质量、抑郁和焦虑症状都有显著的改善作用 170。具体来说：
- 安全与低风险：作为一种非药物干预，正念舞蹈疗法具有安全性高、风险低的特点，非常适合那些希望通过自然方式改善睡眠和整体健康的女性 170。
综合来看，更年期女性的睡眠问题需要综合考量，并采取多方面的干预措施。对于有中重度潮热症状的女性，Fezolinetant等非激素药物可以作为安全有效的选择。同时，结合正念舞蹈疗法等身心实践，不仅能改善睡眠，还能促进情绪健康和整体福祉，让更年期女性能够优雅地度过这一人生阶段。
7.3 学生党：调整作息与减少屏幕的实操建议
对于学生党来说，尤其是大学生，睡眠问题似乎已经成了“家常便饭”。熬夜学习、社交、打游戏，早上又不得不早起上课，这种不规律的作息模式，加上巨大的学业压力，让他们的睡眠质量普遍堪忧。多项研究表明，大学生群体的睡眠质量普遍不佳。例如，一些研究发现睡眠质量与压力、心理健康、学业成绩或手机使用等因素相关 171172173174175。其中，有研究指出，屏幕时间与注意力集中程度无相关性 176。但好消息是，很多睡眠问题都可以通过简单的生活习惯调整来改善。
7.3.1 调整作息：固定起床时间，稳定生物钟
你可能觉得“早睡早起”很难做到，但如果我告诉你，固定起床时间比固定睡觉时间更重要，你是不是会觉得轻松一些？这是因为，我们的生物钟（昼夜节律）对起床时间更为敏感。即使你偶尔晚睡，但只要能每天在固定时间起床，你的生物钟就能逐渐被“校准”，身体就会慢慢适应这个节奏，并在这个时间点前让你产生睡意。
- 固定起床时间：无论前一晚睡了多久，周末还是工作日，都尝试在每天大致相同的时间起床。例如，如果你平时工作日是早上7点起床，那么周末也尽量保持在7点或7点半起床。起初可能会有些困难，但坚持一段时间后，你会发现入睡会变得更容易，早起也变得不那么痛苦。
- 创建睡前例行程序：睡前1-2小时，开始进行一些放松活动，比如洗个热水澡、读纸质书、听轻音乐、做拉伸等，避免剧烈运动和刺激性活动。这会给你的大脑发出信号，告诉它“该准备睡觉了”。
- 白天适度运动：前文提到，适度的运动，特别是力量训练，有助于改善睡眠。但要避免睡前进行剧烈运动，以免身体过于兴奋。
7.3.2 减少屏幕时间：睡前1小时关闭电子设备
这是对学生党来说，尤其需要强调的一点。智能手机、平板电脑等电子设备，是大学生生活不可或缺的一部分，但它们也是睡眠的“隐形杀手”。
- 蓝光影响：睡前接触电子屏幕可能影响睡眠，而电子屏幕发出的蓝光会抑制褪黑素的分泌，干扰你的生物钟，让你更难入睡。
- 大脑兴奋：睡前沉迷于社交媒体、游戏、短视频，会让大脑保持高度兴奋，难以平静。有研究显示，长时间的屏幕使用，特别是夜间使用，与睡眠质量差存在相关性 176177，例如有研究发现休闲屏幕时间与晚睡有关 178。一项针对大学生群体的研究发现，平均每天屏幕使用时间超过8小时与睡眠质量差显著相关 179。甚至有研究显示，减少屏幕时间（例如每天不超过2小时）能显著改善睡眠质量 180。
具体方案：
- 睡前1小时关闭所有电子设备：这不是一个可选项，而是一个必须严格执行的规则。把手机、电脑、平板等都请出卧室，或者至少远离你的床。
- 寻找替代活动：睡前不用电子设备，可能会让你感到无聊或无所适从。这时候，你可以尝试以下替代活动：
- 听有声书或播客：选择一些内容轻松、语速平缓的有声书或助眠播客。用耳朵去听，避免眼睛受到刺激，同时也能让大脑得到放松。
- 写日记：把一天的所思所想写下来，有助于清理思绪，减轻心理负担。
- 冥想或身体扫描：前文介绍的正念和身体扫描练习，是非常好的睡前放松方式。
- 简单的伸展运动：做一些温和的拉伸，放松身体肌肉。
- 与家人室友聊天：进行轻松愉快的交流，增进感情，也能帮助放松。
7.3.3 其他建议
- 关注心理健康：学业压力、人际关系等都可能导致焦虑和压力，进而影响睡眠。研究显示，压力、焦虑和抑郁是大学生睡眠质量差的重要预测因素 171172175。学会管理压力，必要时寻求心理咨询，对改善睡眠至关重要。甚至有研究表明，通过干预措施减少有问题社交媒体使用，可以降低社交媒体对学业的干扰的可能性 181。
- 睡眠卫生教育：很多学生对睡眠健康缺乏足够的认识。提高睡眠卫生知识，了解如何养成良好的睡眠习惯，是改善睡眠的重要一步 173182183。虽然有系统性综述指出，现有证据尚不足以确定睡眠教育项目对改善大学生睡眠卫生知识、行为或睡眠质量的有效性 184，但其他研究仍表明其具有潜在益处。
总而言之，学生党改善睡眠的关键在于规律作息和限制睡前电子设备使用。这些看似简单的建议，却需要强大的自律性去执行。但请相信，为了你的健康、学业和未来的发展，这份努力绝对值得。
内容由 AI 生成，仅供参考，请仔细甄别
参考文献
1Measuring Sleep Efficiency: What Should the Denominator Be?PubMed
David L Reed, William P Sacco
J Clin Sleep Med. 2016 Feb;12(2):263-6. doi: 10.5664/jcsm.5498.
Inconsistency in operationally defining sleep efficiency (SE) creates confusion with regard to the conceptualization and use of the construct by researchers and clinicians. The source of the inconsistency is the denominator of the widely published operational definition of SE: ratio of total sleep time (TST) to time in bed (TIB) (multiplied by 100 to yield a percentage). When taken literally, TIB includes non-sleep-related activity (e.g., reading, texting, conversing with a partner, watching television) both prior to initiating sleep and after the final awakening. However, the construct of SE refers to TST compared to the amount of time spent attempting to initially fall asleep and sleep discontinuity. Non-sleep related activities in bed do not reflect that construct. Also, time out of bed during nighttime awakenings, a manifestation of sleep discontinuity, should be included in the SE denominator. Using TIB as the denominator can also create a methodological problem when SE is an outcome measure in sleep intervention research. It is proposed that research and practice would benefit by clarifying and adopting a consistent operational definition that more accurately captures the construct of SE. An alternate denominator, duration of the sleep episode (DSE), is suggested, where DSE = sleep onset latency (SOL) + TST + time awake after initial sleep onset but before the final awakening (WASO) + time attempting to sleep after final awakening (TASAFA). The proposed formula for SE would be: SE = TST / DSE (× 100). DSE can be easily calculated using standard sleep diary entries along with one item from the Expanded Consensus Sleep Diary. Implications for insomnia research and practice are discussed.
2Oveporexton, an Oral Orexin Receptor 2-Selective Agonist, in Narcolepsy Type 1.PubMed
Yves Dauvilliers, Giuseppe Plazzi, Emmanuel Mignot, et al.
N Engl J Med. 2025 May 15;392(19):1905-1916. doi: 10.1056/NEJMoa2405847.
BACKGROUND: Narcolepsy type 1 is a disorder of hypersomnolence caused by a loss of orexin neurons, which results in low orexin levels in the brain. METHODS: In this phase 2, randomized, placebo-controlled trial, participants with narcolepsy type 1 received once- or twice-daily oveporexton (TAK-861), an oral orexin receptor 2-selective agonist, or placebo. The primary end point was the mean change from baseline to week 8 in average sleep latency (the time it takes to fall asleep) on the Maintenance of Wakefulness Test (MWT) (range, 0 to 40 minutes; normal, ≥20). Secondary end points included the change from baseline to week 8 in the Epworth Sleepiness Scale (ESS) total score (range, 0 to 24; normal, ≤10), the weekly cataplexy rate at week 8, and the occurrence of adverse events. RESULTS: A total of 90 participants received oveporexton (0.5 mg twice daily, 23 participants; 2 mg twice daily, 21 participants; 2 mg followed by 5 mg daily, 23 participants; and 7 mg once daily, 23 participants), and 22 received placebo. The mean changes from baseline to week 8 in average sleep latency on the MWT were 12.5, 23.5, 25.4, 15.0, and -1.2 minutes, respectively (adjusted P≤0.001 for all comparisons vs. placebo). The mean changes in the ESS total score at week 8 were -8.9, -13.8, -12.8, -11.3, and -2.5, respectively (adjusted P≤0.004 for all comparisons vs. placebo). The weekly incidence of cataplexy at week 8 was 4.24, 3.14, 2.48, 5.89, and 8.76, respectively (adjusted P<0.05 for 2 mg twice daily and 2 mg followed by 5 mg daily vs. placebo). The most common adverse events associated with oveporexton were insomnia (in 48% of the participants; most cases resolved within 1 week), urinary urgency (in 33%), and urinary frequency (in 32%), without any hepatotoxic effects. CONCLUSIONS: In this phase 2 trial involving participants with narcolepsy type 1, oveporexton significantly improved measures of wakefulness, sleepiness, and cataplexy over a period of 8 weeks. (Funded by Takeda Development Center Americas; TAK-861-2001 ClinicalTrials.gov number, NCT05687903.).
3Nutritional Modulation of Sleep Latency, Duration, and Efficiency: A Randomized, Repeated-Measures, Double-Blind Deception Study.PubMed
Carl Langan-Evans, Mark A Hearris, Chloe Gallagher, et al.
Med Sci Sports Exerc. 2023 Feb 1;55(2):289-300. doi: 10.1249/MSS.0000000000003040. Epub 2022 Sep 9.
PURPOSE: This study aimed to test the hypothesis that a novel nutritional blend composed of tryptophan, glycine, magnesium, tart cherry powder, and l -theanine enhances subjective and objective measures of sleep during free living conditions. METHODS: In a randomized, repeated-measures crossover and double-blind deception design, participants ( n = 9 males and 7 females, age = 24 ± 3 yr, body mass = 69.8 ± 11.6 kg, stature = 170.8 ± 9.1 cm) completed a 3-d familiarization period, followed by 3-d intervention and placebo trials. Subjective Pittsburgh Quality Sleep Index, Core Consensus Sleep Diary, and Karolinska Sleepiness Scale survey tools, alongside objective actigraphy measures of sleep, were assessed, with daily nutritional intake, activity, and light exposure standardized between trials. Participants provided daily urine samples for assessment of targeted and untargeted metabolomes. RESULTS: The intervention trial reduced sleep onset latency (-24 ± 25 min; P = 0.002), increased total sleep time (22 ± 32 min; P = 0.01), and increased sleep efficiency (2.4% ± 3.9%; P = 0.03), while also reducing morning sleepiness ( P = 0.02). Throughout the study, 75% of participants remained blinded to sleep assessment as a primary outcome measure, with 56% subjectively indicating improved sleep during the intervention trial. Metabolomic analysis highlighted several significantly altered metabolomes related to sleep regulation between trials, inclusive of 6-sulfatoxymelatonin, d -serine, and l -glutamic acid. CONCLUSIONS: Data demonstrate that using the proposed blend of novel nutritional ingredients during free living conditions reduced sleep onset latency, increased total sleep duration, and increased sleep efficiency, leading to reduced perceptions of morning sleepiness. These effects may be mediated by the upregulation of key metabolites involved in the neurophysiological modulation of the sleep/wake cycle.
4Self-reported sleep bruxism among Finnish symphony orchestra musicians: Associations with perceived sleep-related problems and psychological stress.PubMed
Maurits van Selms, Janine Kroon, Henri Tuomilehto, et al.
Cranio. 2023 Jul;41(4):323-330. doi: 10.1080/08869634.2020.1853310. Epub 2020 Nov 30.
OBJECTIVE: This study aimed to evaluate whether self-reported sleep bruxism among musicians is associated with sleep-related problems and/or psychological stress. METHODS: Eight hundred-thirty-one Finnish orchestra musicians completed a questionnaire that covered, among others, indicators of sleep-related problems, possible sleep bruxism, and stress. RESULTS: In total, 488 questionnaires were completed. The single variable ordinal logistic regression models revealed at least moderate associations between frequency of sleep bruxism and female gender, shorter sleep duration, longer sleep latency, problems in sleeping during concert season, feeling more often tired during the daytime, restless legs, a poor self-rated sleep quality, and more stress experience. The variables that remained in the final model were sleep duration, gender, and stress. CONCLUSION: Musicians who sleep 7 hours or less per night report more sleep bruxism, as compared to those who sleep 8 hours or more. Female gender and high-stress experience were associated with more sleep bruxism.
5Sleep deprivation and obesity in adults: a brief narrative review.PubMed
Christopher B Cooper, Eric V Neufeld, Brett A Dolezal, et al.
BMJ Open Sport Exerc Med. 2018 Oct 4;4(1):e000392. doi: 10.1136/bmjsem-2018-000392. eCollection 2018.
BACKGROUND/AIMS: Obesity and sleep deprivation are two epidemics that pervade developed nations. Their rates have been steadily rising worldwide, especially in the USA. This short communication will explore the link between the two conditions and outline the proposed mechanisms behind their relationship. METHODS: Studies on the topic of sleep and obesity were reviewed, and findings were used to develop a theoretical model for the biological link between short sleep duration and obesity. RESULTS: Individuals who regularly slept less than 7 hours per night were more likely to have higher average body mass indexes and develop obesity than those who slept more. Studies showed that experimental sleep restriction was associated with increased levels of ghrelin, salt retention and inflammatory markers as well as decreased levels of leptin and insulin sensitivity. CONCLUSIONS: There may be a link between obesity and sleep deprivation. We recommend further investigations are to elucidate the potential mechanisms.
6A work-life perspective on sleep and fatigue--looking beyond shift workers.PubMed
Natalie Skinner, Jill Dorrian
Ind Health. 2015;53(5):417-26. doi: 10.2486/indhealth.2015-0009. Epub 2015 May 29.
This study examines sleep and fatigue through a work-life lens. Whilst most often thought of as an issue for shift workers, this study observed that self-reported insufficient sleep and fatigue were prevalent for workers on standard daytime schedules. Using a representative sample of 573 daytime workers (51.3% men; 70.7% aged 25-54 yr) from one Australian state, it was observed that 26.4% of daytime workers never or rarely get the seven hours of sleep a night that is recommended for good health. Those with parenting responsibilites (29.4%) or working long (45+) hours (37.4%) were most likely to report insufficient sleep. Whereas mothers in full-time work were most likely to report frequent fatigue (42.5%). This study highlights the common experience of insufficient sleep and fatigue in a daytime workforce, with significant implications for health and safety at work and outside of work. Stronger and more effective legislation addressing safe and 'decent' working time is clearly needed, along with greater awareness and acceptance within workplace cultures of the need to support reasonable workloads and working hours.
7The Neuroprotective Aspects of Sleep.PubMed
Andy R Eugene, Jolanta Masiak
MEDtube Sci. 2015 Mar;3(1):35-40.
Sleep is an important component of human life, yet many people do not understand the relationship between the brain and the process of sleeping. Sleep has been proven to improve memory recall, regulate metabolism, and reduce mental fatigue. A minimum of 7 hours of daily sleep seems to be necessary for proper cognitive and behavioral function. The emotional and mental handicaps associated with chronic sleep loss as well as the highly hazardous situations which can be contributed to the lack of sleep is a serious concern that people need to be aware of. When one sleeps, the brain reorganizes and recharges itself, and removes toxic waste byproducts which have accumulated throughout the day. This evidence demonstrates that sleeping can clear the brain and help maintain its normal functioning. Multiple studies have been done to determine the effects of total sleep deprivation; more recently some have been conducted to show the effects of sleep restriction, which is a much more common occurrence, have the same effects as total sleep deprivation. Each phase of the sleep cycle restores and rejuvenates the brain for optimal function. When sleep is deprived, the active process of the glymphatic system does not have time to perform that function, so toxins can build up, and the effects will become apparent in cognitive abilities, behavior, and judgment. As a background for this paper we have reviewed literature and research of sleep phases, effects of sleep deprivation, and the glymphatic system of the brain and its restorative effect during the sleep cycle.
8Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults.PubMed
Jennifer Zitser, Isabel Elaine Allen, Neus Falgàs, et al.
PLoS One. 2022 Jun 24;17(6):e0270095. doi: 10.1371/journal.pone.0270095. eCollection 2022.
OBJECTIVES: To investigate the objective sleep influencers behind older adult responses to subjective sleep measures, in this case, the Pittsburgh Sleep Quality Index (PSQI). Based on previous literature, we hypothesized that SE would be associated with PSQI reported sleep disruption. Furthermore, because SOL increases progressively with age and it tends to be easily remembered by the patients, we also expected it to be one of the main predictors of the perceived sleep quality in the elderly. METHODS: We studied 32 cognitively healthy community-dwelling older adults (age 74 ± 0.3 years) who completed an at-home sleep assessment (Zeo, Inc.) and the PSQI. Linear mixed models were used to analyze the association of the objective sleep parameters (measured by the Zeo) with the PSQI total score and sub-scores, adjusting for age, gender, years of education and likelihood of sleep apnea. RESULTS: Objective sleep parameters did not show any association with the PSQI total score. We found that objective measures of Wake after sleep onset (WASO, % and min) were positively associated with the PSQI sleep disturbance component, while SE and Total Sleep Time (TST) were negatively associated with PSQI sleep disturbance. Lastly, objective SE was positively associated with PSQI SE. CONCLUSIONS: Our findings showed that WASO, SE and TST, are associated with PSQI sleep disturbance, where the greater WASO, overall lower SE and less TST, were associated with increased subjective report of sleep disturbance. As expected, subjective (PSQI) and objective measures of SE were related. However, PSQI total score did not relate to any of the objective measures. These results suggest that by focusing on the PSQI total score we may miss the insight this easily administered self-report tool can provide. If interpreted in the right way, the PSQI can provide further insight into cognitively healthy older adults that have the likelihood of objective sleep disturbance.
9Role of melatonin in the regulation of human circadian rhythms and sleep.PubMed
C Cajochen, K Kräuchi, A Wirz-Justice
J Neuroendocrinol. 2003 Apr;15(4):432-7. doi: 10.1046/j.1365-2826.2003.00989.x.
The circadian rhythm of pineal melatonin is the best marker of internal time under low ambient light levels. The endogenous melatonin rhythm exhibits a close association with the endogenous circadian component of the sleep propensity rhythm. This has led to the idea that melatonin is an internal sleep "facilitator" in humans, and therefore useful in the treatment of insomnia and the readjustment of circadian rhythms. There is evidence that administration of melatonin is able: (i) to induce sleep when the homeostatic drive to sleep is insufficient; (ii) to inhibit the drive for wakefulness emanating from the circadian pacemaker; and (iii) induce phase shifts in the circadian clock such that the circadian phase of increased sleep propensity occurs at a new, desired time. Therefore, exogenous melatonin can act as soporific agent, a chronohypnotic, and/or a chronobiotic. We describe the role of melatonin in the regulation of sleep, and the use of exogenous melatonin to treat sleep or circadian rhythm disorders.
10[Sleep-wake cycle mechanisms].PubMed
Flávio Alóe, Alexandre Pinto de Azevedo, Rosa Hasan
Braz J Psychiatry. 2005 May;27 Suppl 1:33-9. doi: 10.1590/s1516-44462005000500007. Epub 2005 Jul 28.
Neurochemically distinct systems interact regulating sleep and wakefulness. Wakefulness is promoted by aminergic, acetylcholinergic brainstem and hypothalamic systems. Each of these arousal systems supports wakefulness and coordinated activity is required for alertness and EEG activation. Neurons in the pons and preoptic area control rapid eye movement and non-rapid eye movement sleep. Mutual inhibition between these wake- and sleep-regulating systems generate behavioral states. An up-to-date understanding of these systems should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.
11Association between obstructive sleep apnea and visceral adiposity index and lipid accumulation product: NHANES 2015-2018.PubMed
Tingfeng Zhou, Shihao Chen, Jiesheng Mao, et al.
Lipids Health Dis. 2024 Apr 10;23(1):100. doi: 10.1186/s12944-024-02081-5.
BACKGROUND: Obesity refers to a significant contributor to the development of obstructive sleep apnea (OSA). Early prediction of OSA usually leads to better treatment outcomes, and this study aims to employ novel metabolic markers, visceral adiposity index (VAI), and lipid accumulation product (LAP) to evaluate the relationship to OSA. METHODS: The data used in the current cross-sectional investigation are from the National Health and Nutrition Examination Survey (NHANES), which was carried out between 2015 and 2018. To examine the correlation between LAP and VAI levels and OSA, multivariate logistic regression analysis was adopted. In addition, various analytical methods were applied, including subgroup analysis, smooth curve fitting, and threshold effect analysis. RESULTS: Among totally 3932 participants, 1934 were included in the OSA group. The median (Q1-Q3) values of LAP and VAI for the participants were 40.25 (21.51-68.26) and 1.27 (0.75-2.21), respectively. Logistic regression studies indicated a positive correlation between LAP, VAI, and OSA risk after adjusting for potential confounding variables. Subgroup analysis revealed a stronger correlation between LAP, VAI levels, and OSA among individuals aged < 60 years. Through smooth curve fitting, specific saturation effects of LAP, VAI, and BMD were identified, with inflection points at 65.684 and 0.428, respectively. CONCLUSION: This study demonstrates that elevated levels of LAP and VAI increase the risk of OSA, suggesting their potential as predictive markers for OSA and advocating for dietary and exercise interventions to mitigate OSA risk in individuals with high LAP and VAI levels.
12Obstructive Sleep Apnea, Hypertension, and Cardiovascular Risk: Epidemiology, Pathophysiology, and Management.PubMed
Liann Abu Salman, Rachel Shulman, Jordana B Cohen
Curr Cardiol Rep. 2020 Jan 18;22(2):6. doi: 10.1007/s11886-020-1257-y.
PURPOSE OF REVIEW: Given the rising prevalence of obstructive sleep apnea (OSA), we aimed to review the epidemiologic and pathophysiologic relationship of OSA, hypertension, and cardiovascular disease, and to summarize recent advances in the treatment of OSA. RECENT FINDINGS: OSA is associated with an elevated risk of hypertension and cardiovascular disease. Several pathophysiologic factors contribute to the relationship between OSA and vascular risk, including neurohormonal dysregulation, endothelial dysfunction, and inflammation. While CPAP reduces blood pressure, it has not been demonstrated to reduce cardiovascular risk. The combination of CPAP and weight loss has a synergistic effect on blood pressure and several metabolic parameters. Adherence to CPAP is poor across studies, potentially contributing to the attenuation of perceived cardiovascular benefit from CPAP therapy. A greater emphasis on adherence to CPAP and the combination of CPAP and weight loss are central to reducing cardiovascular risk among individuals with OSA.
13OSA and Chronic Respiratory Disease: Mechanisms and Epidemiology.PubMed
Brian W Locke, Janet J Lee, Krishna M Sundar
Int J Environ Res Public Health. 2022 Apr 30;19(9):5473. doi: 10.3390/ijerph19095473.
Obstructive sleep apnea (OSA) is a highly prevalent disorder that has profound implications on the outcomes of patients with chronic lung disease. The hallmark of OSA is a collapse of the oropharynx resulting in a transient reduction in airflow, large intrathoracic pressure swings, and intermittent hypoxia and hypercapnia. The subsequent cytokine-mediated inflammatory cascade, coupled with tractional lung injury, damages the lungs and may worsen several conditions, including chronic obstructive pulmonary disease, asthma, interstitial lung disease, and pulmonary hypertension. Further complicating this is the sleep fragmentation and deterioration of sleep quality that occurs because of OSA, which can compound the fatigue and physical exhaustion often experienced by patients due to their chronic lung disease. For patients with many pulmonary disorders, the available evidence suggests that the prompt recognition and treatment of sleep-disordered breathing improves their quality of life and may also alter the course of their illness. However, more robust studies are needed to truly understand this relationship and the impacts of confounding comorbidities such as obesity and gastroesophageal reflux disease. Clinicians taking care of patients with chronic pulmonary disease should screen and treat patients for OSA, given the complex bidirectional relationship OSA has with chronic lung disease.
14High body mass index and sleep problems during pregnancy: A meta-analysis and meta-regression of observational studies.PubMed
Ying Lau, Ling Jie Cheng, Daniel Guang Hui Chee, et al.
J Sleep Res. 2022 Feb;31(1):e13443. doi: 10.1111/jsr.13443. Epub 2021 Jul 22.
Despite the well-established correlation of weight and sleeping problems, little is known about the nature of the association. The present study examined whether pregnant women with high body mass index have a risk of developing sleep problems, and identified any covariates that affect this relationship. We systematically searched electronic databases, specialized journals, various clinical trial registries, grey literature databases and the reference list of the identified studies. All observational studies were obtained from inception until 9 August 2020. The Newcastle-Ottawa Scale was adopted to assess the quality of studies. Stata software was used to conduct meta-analysis and meta-regression. Forty-six observational studies involving 2,240,804 participants across 16 countries were included. Quality assessment scores ranged from 4 to 10 (median = 6). Meta-analyses revealed that the risk of sleep apnea, habitual snoring, short sleep duration and poor sleep quality is increased in pregnant women with high body mass index, but not for daytime sleepiness, insomnia or restless legs syndrome. Subgroup differences were detected on body mass index between different regions, nature of population, year of publication, age group and study quality. Random-effects meta-regression analyses showed that year and quality of publication were covariates on the relationships between pre-pregnant body mass index and sleep apnea risk. Our review shows that sleep apnea, habitual snoring, short sleep duration and poor sleep quality are important concerns for pregnant women with high body mass index. Developing screening and targeted interventions is recommended to promote efficacious perinatal care.
15Introduction and reflections on the comparative physiology of sleep and circadian rhythms.PubMed
Russell G Foster
J Comp Physiol B. 2024 Jun;194(3):225-231. doi: 10.1007/s00360-024-01567-z. Epub 2024 Jun 10.
Circadian rhythms and the sleep/wake cycle allows us, and most life on Earth, to function optimally in a dynamic world, adjusting all aspects of biology to the varied and complex demands imposed by the 24-hour rotation of the Earth upon its axis. A key element in understanding these rhythms, and the success of the field in general, has been because researchers have adopted a comparative approach. Across all taxa, fundamental questions relating to the generation and regulation of sleep and circadian rhythms have been address using biochemical, molecular, cellular, system and computer modelling techniques. Furthermore, findings have been placed into an ecological and evolutionary context. By addressing both the "How" - mechanistic, and "Why" - evolutionary questions in parallel, the field has achieved remarkable successes, including how circadian rhythms are generated and regulated by light. Yet many key questions remain. In this special issue on the Comparative Physiology of Sleep and Circadian Rhythms, celebrating the 100th anniversary of the Journal of Comparative Physiology, important new discoveries are detailed. These findings illustrate the power of comparative physiology to address novel questions and demonstrate that sleep and circadian physiology are embedded within the biological framework of an organism.
16Association between circadian rhythm disruption and polycystic ovary syndrome.PubMed
Fangfang Wang, Ningning Xie, Yan Wu, et al.
Fertil Steril. 2021 Mar;115(3):771-781. doi: 10.1016/j.fertnstert.2020.08.1425. Epub 2020 Dec 24.
OBJECTIVE: To explore the association of circadian rhythm disruption with polycystic ovary syndrome (PCOS) and the potential underlying mechanism in ovarian granulosa cells (GCs). DESIGN: Multicenter questionnaire-based survey, in vivo and ex vivo studies. SETTING: Twelve hospitals in China, animal research center, and research laboratory of a women's hospital. PATIENTS/ANIMALS: A total of 436 PCOS case subjects and 715 control subjects were recruited for the survey. In vivo and ex vivo studies were conducted in PCOS-model rats and on ovarian GCs collected from women with PCOS and control subjects. INTERVENTION(S): The PCOS rat model was established with the use of testosterone propionate. MAIN OUTCOME MEASURE(S): Assay for transposase-accessible chromatin with high-throughput sequencing (ATAC-seq), RNA sequencing, rhythmicity analysis, functional enrichment analysis. RESULT(S): There was a significant correlation between night shift work and PCOS. PCOS-model rats presented distinct differences in the circadian variation of corticotropin-releasing hormone, adrenocorticotropic hormone, prolactin, and a 4-h phase delay in thyrotropic hormone levels. The motif enrichment analysis of ATAC-seq revealed the absence of clock-related transcription factors in specific peaks of PCOS group, and RNA sequencing ex vivo at various time points over 24 hours demonstrated the differential rhythmic expression patterns of women with PCOS. Kyoto Encyclopedia of Genes and Genomes analysis further highlighted metabolic dysfunction, including both carbohydrate and amino acid metabolism and the tricarboxylic acid cycle. CONCLUSION(S): There is a significant association of night shift work with PCOS, and genome-wide chronodisruption exists in ovarian GCs.
17Social jetlag and obesity.PubMed
Till Roenneberg, Karla V Allebrandt, Martha Merrow, et al.
Curr Biol. 2012 May 22;22(10):939-43. doi: 10.1016/j.cub.2012.03.038. Epub 2012 May 10.
Obesity has reached crisis proportions in industrialized societies. Many factors converge to yield increased body mass index (BMI). Among these is sleep duration. The circadian clock controls sleep timing through the process of entrainment. Chronotype describes individual differences in sleep timing, and it is determined by genetic background, age, sex, and environment (e.g., light exposure). Social jetlag quantifies the discrepancy that often arises between circadian and social clocks, which results in chronic sleep loss. The circadian clock also regulates energy homeostasis, and its disruption-as with social jetlag-may contribute to weight-related pathologies. Here, we report the results from a large-scale epidemiological study, showing that, beyond sleep duration, social jetlag is associated with increased BMI. Our results demonstrate that living "against the clock" may be a factor contributing to the epidemic of obesity. This is of key importance in pending discussions on the implementation of Daylight Saving Time and on work or school times, which all contribute to the amount of social jetlag accrued by an individual. Our data suggest that improving the correspondence between biological and social clocks will contribute to the management of obesity.
18Social jetlag and obesity: A systematic review and meta-analysis.PubMed
Arman Arab, Elham Karimi, Marta Garaulet, et al.
Obes Rev. 2024 Mar;25(3):e13664. doi: 10.1111/obr.13664. Epub 2023 Dec 10.
Social jetlag, the weekly variation in sleep timing, is proposed to contribute to increased obesity risk, potentially because of the misalignment of behavioral cycles relative to the endogenous circadian timing system. This systematic review and meta-analysis aim to determine the association between social jetlag and adiposity-related measures using observational studies. We reviewed 477 references, of which 43 studies met inclusion criteria with a total sample size of 231,648. There was a positive association between social jetlag and body mass index (correlation coefficient [r]: 0.12; 95%CI, 0.07, 0.17; P < 0.001; I = 94.99%), fat mass (r: 0.10; 95%CI, 0.05, 0.15; P < 0.001; I = 0.00%), fat mass index (fat mass divided by height in meter squared, β: 0.14 kg/m ; 95%CI, 0.05, 0.23; P < 0.001; I = 56.50%), percent of body fat (r: 0.37; 95%CI, 0.33, 0.41; P < 0.001; I = 96.17%), waist circumference (r: 0.15; 95%CI, 0.06, 0.24; P = 0.001; I = 90.83%), and the risk of having overweight/obesity (odds ratio: 1.20; 95%CI, 1.02, 1.140; P = 0.039; I = 98.25%). Social jetlag is positively and consistently associated with multiple obesity-related anthropometric measures. Further studies are needed to test causality, underlying mechanisms, and whether obesity interventions based on increasing regularity of the sleep/wake cycle can aid in the battle against the obesity pandemic.
19Role of sleep quality in the acceleration of biological aging and its potential for preventive interaction on air pollution insults: Findings from the UK Biobank cohort.PubMed
Xu Gao, Ninghao Huang, Xinbiao Guo, et al.
Aging Cell. 2022 May;21(5):e13610. doi: 10.1111/acel.13610. Epub 2022 Apr 14.
Sleep has been associated with aging and relevant health outcomes, but the causal relationship remains inconclusive. In this study, we investigated the associations of sleep behaviors with biological ages (BAs) among 363,886 middle and elderly adults from UK Biobank. Sleep index (0 [worst]-6 [best]) of each participant was retrieved from the following six sleep behaviors: snoring, chronotype, daytime sleepiness, sleep duration, insomnia, and difficulties in getting up. Two BAs, the KDM-biological age and PhenoAge, were estimated by corresponding algorithms based on clinical traits, and their residual discrepancies with chronological age were defined as the age accelerations (AAs). We first observed negative associations between the sleep index and the two AAs, and demonstrated that the change of AAs could be the consequence of sleep quality using Mendelian randomization with genetic risk scores of sleep index and BAs. Particularly, a one-unit increase in sleep index was associated with 0.104- and 0.119-year decreases in KDM-biological AA and PhenoAge acceleration, respectively. Air pollution is another key driver of aging. We further observed significant independent and joint effects of sleep and air pollution (PM and NO ) on AAs. Sleep quality also showed a modifying effect on the associations of elevated PM and NO levels with accelerated AAs. For instance, an interquartile range increase in PM level was associated with 0.009-, 0.044-, and 0.074-year increase in PhenoAge acceleration among people with high (5-6), medium (3-4), and low (0-2) sleep index, respectively. Our findings elucidate that better sleep quality could lessen accelerated biological aging resulting from air pollution.
20The Molecular Relationship between Stress and Insomnia.PubMed
Jasmine N Birch, William M Vanderheyden
Adv Biol (Weinh). 2022 Nov;6(11):e2101203. doi: 10.1002/adbi.202101203. Epub 2022 Jul 13.
The bi-directional relationship between sleep and stress has been actively researched as sleep disturbances and stress have become increasingly common in society. Interestingly, the brain and underlying neural circuits important for sleep regulation may respond uniquely to stress that leads to post-traumatic stress disorder (PTSD) and stress that does not. In stress that does not lead to PTSD, the hypothalamic-pituitary-adrenal axis (HPA) pathway is activated normally that results in sympathetic nervous system activation that allows the brain and body to return to baseline functioning. However, exposure to stress that leads to PTSD, causes enhanced negative feedback of this same pathway and results in long-term physiological and psychological changes. In this review, how stress regulates glucocorticoid signaling pathways in brain glial cells called astrocytes, and then mediates stress-induced insomnia are examined. Astrocytes are critical sleep regulatory cells and their connections to sleep and stress due to disturbed glucocorticoid signaling provide a novel mechanism to explain how stress leads to insomnia. This review will examine the interactions of stress neurobiology, astrocytes, sleep, and glucocorticoid signaling pathways and will examine the how stress that leads to PTSD and stress that does not impacts sleep-regulatory processes.
21The interaction between sleep quality and academic performance.PubMed
K Ahrberg, M Dresler, S Niedermaier, et al.
J Psychiatr Res. 2012 Dec;46(12):1618-22. doi: 10.1016/j.jpsychires.2012.09.008. Epub 2012 Oct 3.
Sleep quality has significant effects on cognitive performance and is influenced by multiple factors such as stress. Contrary to the ideal, medical students and residents suffer from sleep deprivation and stress at times when they should achieve the greatest amount of learning. In order to examine the relationship between sleep quality and academic performance, 144 medical students undertaking the pre-clinical board exam answered a survey regarding their subjective sleep quality (Pittsburgh sleep quality index, PSQI), grades and subjective stress for three different time points: semester, pre- and post-exam. Academic performance correlated with stress and sleep quality pre-exam (r = 0.276, p < 0.001 and r = 0.158, p < 0.03, note that low performance meant low sleep quality and high stress), however not with the stress or sleep quality during the semester and post-exam. 59% of all participants exhibited clinically relevant sleep disturbances (PSQI > 5) during exam preparation compared to 29% during the semester and 8% post-exam. This study shows that in medical students it is not the generally poor sleepers, who perform worse in the medical board exams. Instead students who will perform worse on their exams seem to be more stressed and suffer from poor sleep quality. However, poor sleep quality may negatively impact test performance as well, creating a vicious circle. Furthermore, the rate of sleep disturbances in medical students should be cause for intervention.
22Sleep patterns and predictors of disturbed sleep in a large population of college students.PubMed
Hannah G Lund, Brian D Reider, Annie B Whiting, et al.
J Adolesc Health. 2010 Feb;46(2):124-32. doi: 10.1016/j.jadohealth.2009.06.016. Epub 2009 Aug 3.
PURPOSE: To characterize sleep patterns and predictors of poor sleep quality in a large population of college students. This study extends the 2006 National Sleep Foundation examination of sleep in early adolescence by examining sleep in older adolescents. METHOD: One thousand one hundred twenty-five students aged 17 to 24 years from an urban Midwestern university completed a cross-sectional online survey about sleep habits that included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, the Horne-Ostberg Morningness-Eveningness Scale, the Profile of Mood States, the Subjective Units of Distress Scale, and questions about academic performance, physical health, and psychoactive drug use. RESULTS: Students reported disturbed sleep; over 60% were categorized as poor-quality sleepers by the PSQI, bedtimes and risetimes were delayed during weekends, and students reported frequently taking prescription, over the counter, and recreational psychoactive drugs to alter sleep/wakefulness. Students classified as poor-quality sleepers reported significantly more problems with physical and psychological health than did good-quality sleepers. Students overwhelmingly stated that emotional and academic stress negatively impacted sleep. Multiple regression analyses revealed that tension and stress accounted for 24% of the variance in the PSQI score, whereas exercise, alcohol and caffeine consumption, and consistency of sleep schedule were not significant predictors of sleep quality. CONCLUSIONS: These results demonstrate that insufficient sleep and irregular sleep-wake patterns, which have been extensively documented in younger adolescents, are also present at alarming levels in the college student population. Given the close relationships between sleep quality and physical and mental health, intervention programs for sleep disturbance in this population should be considered.
23Chronic insomnia, REM sleep instability and emotional dysregulation: A pathway to anxiety and depression?PubMed
Dieter Riemann, Raphael J Dressle, Fee Benz, et al.
J Sleep Res. 2025 Apr;34(2):e14252. doi: 10.1111/jsr.14252. Epub 2024 May 29.
The world-wide prevalence of insomnia disorder reaches up to 10% of the adult population. Women are more often afflicted than men, and insomnia disorder is a risk factor for somatic and mental illness, especially depression and anxiety disorders. Persistent hyperarousals at the cognitive, emotional, cortical and/or physiological levels are central to most theories regarding the pathophysiology of insomnia. Of the defining features of insomnia disorder, the discrepancy between minor objective polysomnographic alterations of sleep continuity and substantive subjective impairment in insomnia disorder remains enigmatic. Microstructural alterations, especially in rapid eye movement sleep ("rapid eye movement sleep instability"), might explain this mismatch between subjective and objective findings. As rapid eye movement sleep represents the most highly aroused brain state during sleep, it might be particularly prone to fragmentation in individuals with persistent hyperarousal. In consequence, mentation during rapid eye movement sleep may be toned more as conscious-like wake experience, reflecting pre-sleep concerns. It is suggested that this instability of rapid eye movement sleep is involved in the mismatch between subjective and objective measures of sleep in insomnia disorder. Furthermore, as rapid eye movement sleep has been linked in previous works to emotional processing, rapid eye movement sleep instability could play a central role in the close association between insomnia and depressive and anxiety disorders.
24Psychobiotic JYLP-326 relieves anxiety, depression, and insomnia symptoms in test anxious college modulating the gut microbiota and its metabolism.PubMed
Ruizhe Zhu, Yilin Fang, Hongyu Li, et al.
Front Immunol. 2023 Mar 23;14:1158137. doi: 10.3389/fimmu.2023.1158137. eCollection 2023.
INTRODUCTION: Test anxiety is a common issue among college students, which can affect their physical and psychological health. However, effective interventions or therapeutic strategies are still lacking. This study aims to evaluate the potential effects of JYLP-326 on test anxious college students. METHODS: Sixty anxious students were enrolled and randomly allocated to the placebo group and the probiotic group. Both groups were instructed to take placebo and JYLP-326 products twice per day for three weeks, respectively. Thirty unanxious students with no treatments were assigned to a regular control group. The anxiety, depression, and insomnia questionnaires were used to measure students' mental states at the baseline and the end of this study. 16S rRNA sequencing and untargeted metabolomics were performed to analyze the changes in the gut microbiota and fecal metabolism. RESULTS: The questionnaire results suggested that JYLP-326 administration could relieve the symptoms of anxiety, depression, and insomnia in test anxious students. The gut microbiomes of the placebo group showed a significantly greater diversity index than the control group (p < 0.05). An increased abundance of and at the genus level was observed in the placebo group, and the relative abundance of and decreased. Whereas, JYLP-326 administration could partly restore the disturbed gut microbiota. Additionally, test anxiety was correlated with disordered fecal metabolomics such as a higher Ethyl sulfate and a lower Cyclohexylamine, which could be reversed after taking JYLP-326. Furthermore, the changed microbiota and fecal metabolites were significantly associated with anxiety-related symptoms. CONCLUSION: The results indicate that the intervention of JYLP-326 could be an effective strategy to alleviate anxiety, depression, and insomnia in test anxious college students. The potential mechanism underlying this effect could be related to the regulation of gut microbiota and fecal metabolites.
25Subjective and objective quality of sleep with radiant or convection cooling systems: a randomized, cross-over trial.PubMed
Insung Park, Yufei Cui, Fusae Kawana, et al.
Sci Rep. 2025 Oct 8;15(1):35119. doi: 10.1038/s41598-025-19163-8.
Sleep is influenced by environmental factors, and hot ambient temperature undermines sleep quality. Considering the global warming, it becomes increasingly important to keep bedroom temperature cool in the summer. Today, two electrical cooling systems are available: convection and radiant. Convection air cooling system supplies cooled air-flow. Radiant cooling system cools the room through radiation from the cooled surfaces, moisture condensation on which is prevented by reheated refrigeration cycle system. The present study was a randomized, cross-over trial setting room air temperature at 26 ℃ to compare subjective and objective quality of sleep between convection and radiant cooling in 7 healthy women. Subjective and objective quality of sleep were assessed by Oguri-Shirakawa-Azumi Sleep Inventory and EEG-based sleep parameters, respectively. Compared with convection cooling, radiant cooling provided lower relative humidity and air flow. Refreshness, one of the 4 indices of subjective quality of sleep, was higher with radiant cooling. Among the EEG-based sleep parameters, sleep efficiency was higher and sleep latency was shorter with radiant cooling. In spite of similar ambient room temperature, difference in cooling (radiant vs. convection) and/or dehumidifying (ordinary air conditioning vs. reheated refrigeration cycle) method provided difference in thermal comfort affecting subjective and objective quality of sleep.
26Characteristics of the infant thermal environment in the control population of a case-control study of SIDS.PubMed
A L Ponsonby, T Dwyer, J A Cochrane, et al.
J Paediatr Child Health. 1992;28 Suppl 1:S36-40. doi: 10.1111/j.1440-1754.1992.tb02731.x.
This report examines the thermal environment during last sleep of a control population to investigate how the thermal environment of the infant's bedroom varies by season, external temperature and by certain maternal and infant characteristics. Two age-matched control infants were chosen for each case, one of which was also matched on birthweight. The home visits were not pre-arranged and were matched on climatic conditions, time of year and time period of day for the index case. The initial response rate for controls (n = 108) was 86%. Although there was a large amount of variation in the infant thermal environment, thermal insulation correlated with room temperature (r = -0.44, P = 0.0001) and external temperature (r = -0.30, P = 0.002). The thermal environment of the infant, as defined by excess thermal insulation for room temperature, did not vary by indoor or outdoor temperature, but higher average values were observed in teenage mothers (mean difference = 2.7 tog [95% Cl = 0.3, 5.2]), infants who slept in an adult bed (mean difference = 2.6 tog [-0.1, 5.4]) and infants with an illness (mean difference = 0.8 tog [-0.3, 1.9]). There was a tendency for the thermal environment of infants to be higher and more variable during winter, supporting previous hypotheses that paradoxical overheating may occur in some infants during winter. Further work is required to provide a set of recommendations on the optimal thermal conditions for post-neonatal infants.
27Systematic review of light exposure impact on human circadian rhythm.PubMed
Leena Tähkämö, Timo Partonen, Anu-Katriina Pesonen
Chronobiol Int. 2019 Feb;36(2):151-170. doi: 10.1080/07420528.2018.1527773. Epub 2018 Oct 12.
Light is necessary for life, and artificial light improves visual performance and safety, but there is an increasing concern of the potential health and environmental impacts of light. Findings from a number of studies suggest that mistimed light exposure disrupts the circadian rhythm in humans, potentially causing further health impacts. However, a variety of methods has been applied in individual experimental studies of light-induced circadian impacts, including definition of light exposure and outcomes. Thus, a systematic review is needed to synthesize the results. In addition, a review of the scientific evidence on the impacts of light on circadian rhythm is needed for developing an evaluation method of light pollution, i.e., the negative impacts of artificial light, in life cycle assessment (LCA). The current LCA practice does not have a method to evaluate the light pollution, neither in terms of human health nor the ecological impacts. The systematic literature survey was conducted by searching for two concepts: light and circadian rhythm. The circadian rhythm was searched with additional terms of melatonin and rapid-eye-movement (REM) sleep. The literature search resulted to 128 articles which were subjected to a data collection and analysis. Melatonin secretion was studied in 122 articles and REM sleep in 13 articles. The reports on melatonin secretion were divided into studies with specific light exposure (101 reports), usually in a controlled laboratory environment, and studies of prevailing light conditions typical at home or work environments (21 studies). Studies were generally conducted on adults in their twenties or thirties, but only very few studies experimented on children and elderly adults. Surprisingly many studies were conducted with a small sample size: 39 out of 128 studies were conducted with 10 or less subjects. The quality criteria of studies for more profound synthesis were a minimum sample size of 20 subjects and providing details of the light exposure (spectrum or wavelength; illuminance, irradiance or photon density). This resulted to 13 qualified studies on melatonin and 2 studies on REM sleep. Further analysis of these 15 reports indicated that a two-hour exposure to blue light (460 nm) in the evening suppresses melatonin, the maximum melatonin-suppressing effect being achieved at the shortest wavelengths (424 nm, violet). The melatonin concentration recovered rather rapidly, within 15 min from cessation of the exposure, suggesting a short-term or simultaneous impact of light exposure on the melatonin secretion. Melatonin secretion and suppression were reduced with age, but the light-induced circadian phase advance was not impaired with age. Light exposure in the evening, at night and in the morning affected the circadian phase of melatonin levels. In addition, even the longest wavelengths (631 nm, red) and intermittent light exposures induced circadian resetting responses, and exposure to low light levels (5-10 lux) at night when sleeping with eyes closed induced a circadian response. The review enables further development of an evaluation method of light pollution in LCA regarding the light-induced impacts on human circadian system.
28The inner clock-Blue light sets the human rhythm.PubMed
Siegfried Wahl, Moritz Engelhardt, Patrick Schaupp, et al.
J Biophotonics. 2019 Dec;12(12):e201900102. doi: 10.1002/jbio.201900102. Epub 2019 Sep 2.
Visible light synchronizes the human biological clock in the suprachiasmatic nuclei of the hypothalamus to the solar 24-hour cycle. Short wavelengths, perceived as blue color, are the strongest synchronizing agent for the circadian system that keeps most biological and psychological rhythms internally synchronized. Circadian rhythm is important for optimum function of organisms and circadian sleep-wake disruptions or chronic misalignment often may lead to psychiatric and neurodegenerative illness. The beneficial effect on circadian synchronization, sleep quality, mood, and cognitive performance depends not only on the light spectral composition but also on the timing of exposure and its intensity. Exposure to blue light during the day is important to suppress melatonin secretion, the hormone that is produced by the pineal gland and plays crucial role in circadian rhythm entrainment. While the exposure to blue is important for keeping organism's wellbeing, alertness, and cognitive performance during the day, chronic exposure to low-intensity blue light directly before bedtime, may have serious implications on sleep quality, circadian phase and cycle durations. This rises inevitably the need for solutions to improve wellbeing, alertness, and cognitive performance in today's modern society where exposure to blue light emitting devices is ever increasing.
29[Light pollution].PubMed
Jean-Louis Dufier, Yvan Touitou
Rev Prat. 2022 Feb;72(2):141-146.
LIGHT POLLUTION Artificial light can be a polluting agent deleterious for the retina, in relation to the toxicity of the blue band (380-500 nm) of the visible spectrum (380-700nm) specifically used in light-emitting diodes (LEDs). Photo-toxicity results from photochemical damage to the pigmented epithelium and retinal photoreceptors responsible for the visual function of the retina. Their photosensitive pigments, opsins for the cones and rhodopsin for the sticks, are consumed during the day and regenerated at night. Exposure to light at night seriously disrupts their metabolism. Photo-toxicity, along with heredity, is a major factor in degenerative diseases of the retina with, in addition to, the impact of age and tobacco for the most common of them, age-related macular degeneration: ARMD.Exposure to artificial light at night (LAN) has a deleterious effect on the internal clock. Intrinsically photosensitive ganglion cells (ipRGSs) are responsible for the non-visual functions of the retina, and perceive the light signal that is transmitted to the internal clock to reach the pineal gland. Light inhibits the secretion of melatonin and is able to advance or delay the clock depending on the time of exposure, causing desynchronization. Shift and night workers, like teenagers, are exposed to LAN. The incidence of breast cancer, higher in nurses exposed to LAN, is related to melatonin inhibition, sleep deprivation and desynchronization. The exposure of adolescents to screens is also questionable because the LEDs of the devices emit a blue light, the impact of which on the clock is considerable. The chronic desynchronizations of both shiftworkers and adolescents should be considered a major public health concern.
30Evening and night exposure to screens of media devices and its association with subjectively perceived sleep: Should "light hygiene" be given more attention?PubMed
Michal Šmotek, Eva Fárková, Denisa Manková, et al.
Sleep Health. 2020 Aug;6(4):498-505. doi: 10.1016/j.sleh.2019.11.007. Epub 2020 Mar 18.
OBJECTIVE: The aim of the study was to examine subjective sleep quality in a population of healthy volunteers and its association with evening and night light exposure to screens of media devices. METHODS: A total of 693 participants (mean age 31.2±11.4 years, 159 men, and 538 women) completed an online questionnaire battery consisting of several sleep-related questionnaires: PSQI, FSS, MCTQ, MEQ, and added questions assessing the timing and character the evening and night exposure to electronical devices (TV, PC, tablets, and phones), and the use of various filters blocking short-wavelength light. RESULTS: Statistical analyses show that longer cumulative exposure to screen light in the evening was associated with greater sleep inertia in the morning (P = .019, η=0.141) and longer sleep latency on workdays P = .038, η=0.135). Furthermore, exposure to screen light 1.5 h before sleep or during night awakenings was also associated with a decreased chance to wake up before alarm clock (P = .003, d=0.30), larger social jet lag (P < .001, d=0.15), more daytime dysfunction (P < .001, d=0.40), decreased subjective sleep quality (P = .024, d=0.16), and more fatigue (P < .001, d=0.52). A statistical trend for an increase in duration of sleep on weekdays (P = .058, d=0.23) was also found in participants using blue-light filters in the evening hours. DISCUSSION: Our results are in line with other studies that converge to show the negative association of evening and night exposure to short-wavelength light on subjective and objective sleep parameters. Results suggest that light hygiene in general population should be given more attention not only in the context of clinical sleep medicine but also in the realm of public health.
31Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study.PubMed
Gadi Lissak
Environ Res. 2018 Jul;164:149-157. doi: 10.1016/j.envres.2018.01.015. Epub 2018 Feb 27.
UNLABELLED: A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior. CONCLUSIONS: Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.
32Disruption of adolescents' circadian clock: The vicious circle of media use, exposure to light at night, sleep loss and risk behaviors.PubMed
Yvan Touitou, David Touitou, Alain Reinberg
J Physiol Paris. 2016 Nov;110(4 Pt B):467-479. doi: 10.1016/j.jphysparis.2017.05.001. Epub 2017 May 12.
Although sleep is a key element in adolescent development, teens are spending increasing amounts of time online with health risks related to excessive use of electronic media (computers, smartphones, tablets, consoles…) negatively associated with daytime functioning and sleep outcomes. Adolescent sleep becomes irregular, shortened and delayed in relation with later sleep onset and early waking time due to early school starting times on weekdays which results in rhythm desynchronization and sleep loss. In addition, exposure of adolescents to the numerous electronic devices prior to bedtime has become a great concern because LEDs emit much more blue light than white incandescent bulbs and compact fluorescent bulbs and have therefore a greater impact on the biological clock. A large number of adolescents move to evening chronotype and experience a misalignment between biological and social rhythms which, added to sleep loss, results in e.g. fatigue, daytime sleepiness, behavioral problems and poor academic achievement. This paper on adolescent circadian disruption will review the sensitivity of adolescents to light including LEDs with the effects on the circadian system, the crosstalk between the clock and the pineal gland, the role of melatonin, and the behavior of some adolescents(media use, alcohol consumption, binge drinking, smoking habits, stimulant use…). Lastly, some practical recommendations and perspectives are put forward. The permanent social jet lag resulting in clock misalignment experienced by a number of adolescents should be considered as a matter of public health.
33Screen time and sleep among school-aged children and adolescents: a systematic literature review.PubMed
Lauren Hale, Stanford Guan
Sleep Med Rev. 2015 Jun;21:50-8. doi: 10.1016/j.smrv.2014.07.007. Epub 2014 Aug 12.
We systematically examined and updated the scientific literature on the association between screen time (e.g., television, computers, video games, and mobile devices) and sleep outcomes among school-aged children and adolescents. We reviewed 67 studies published from 1999 to early 2014. We found that screen time is adversely associated with sleep outcomes (primarily shortened duration and delayed timing) in 90% of studies. Some of the results varied by type of screen exposure, age of participant, gender, and day of the week. While the evidence regarding the association between screen time and sleep is consistent, we discuss limitations of the current studies: 1) causal association not confirmed; 2) measurement error (of both screen time exposure and sleep measures); 3) limited data on simultaneous use of multiple screens, characteristics and content of screens used. Youth should be advised to limit or reduce screen time exposure, especially before or during bedtime hours to minimize any harmful effects of screen time on sleep and well-being. Future research should better account for the methodological limitations of the extant studies, and seek to better understand the magnitude and mechanisms of the association. These steps will help the development and implementation of policies or interventions related to screen time among youth.
34Digital media use and sleep in late adolescence and young adulthood: A systematic review.PubMed
Louise As Brautsch, Lisbeth Lund, Martin M Andersen, et al.
Sleep Med Rev. 2023 Apr;68:101742. doi: 10.1016/j.smrv.2022.101742. Epub 2022 Dec 31.
Despite much attention on digital media use and young peoples' sleep, the literature on digital media and its impact on sleep in older adolescents and young adults remains to be synthesized. We conducted a systematic review of studies including young people aged 16-25 years. We searched Medline, Web of Science, and CINAHL for observational studies, identifying 60 studies. These studies were assessed for methodological quality. Only studies rated as moderate or high-quality studies were included (n = 42). A narrative synthesis summarized the impact of digital media use on eight sleep outcomes: Bedtime; Sleep onset latency or problems falling asleep; Sleep duration; Early awakening; Sleep disturbance; Daytime tiredness and function; Sleep deficits; Sleep quality. In summary, digital media use was associated to shorter sleep duration and poorer sleep quality. These associations were found for general screen use and use of mobile phone, computer, internet, and social media, but not for television, game console, and tablet use. Most studies investigating bedtime or nighttime use found associations to poor sleep outcomes. Later bedtime and daytime tiredness were associated with mobile phone use at night. Additional research is warranted to draw solid conclusions about the causal direction and to understand the underlying mechanisms.
35Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review.PubMed
Jianghong Liu, Susan Riesch, Joyce Tien, et al.
J Pediatr Health Care. 2022 Mar-Apr;36(2):99-109. doi: 10.1016/j.pedhc.2021.06.003. Epub 2021 Jul 30.
INTRODUCTION: Screen media overuse is seen as a public health concern because of its negative effects on child and adolescent health. This integrative literature review examines recent empirical evidence on the relationship between screen media overuse and physical, cognitive, and emotional/behavioral outcomes in children and adolescents. METHODS: Empirical research of experimental design, observational studies, and systematic reviews from several data sources was reviewed and synthesized to form the basis of this integrative review. RESULTS: Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems. Bidirectional associations may exist. DISCUSSION: Findings support the importance of understanding the impact of screen media use on health and wellbeing. Generating screen time guidelines and developing effective prevention/intervention strategies are critical to mitigating screen media overuse and its adverse outcomes in children and families.
36Effects of smartphone use with and without blue light at night in healthy adults: A randomized, double-blind, cross-over, placebo-controlled comparison.PubMed
Jung-Yoon Heo, Kiwon Kim, Maurizio Fava, et al.
J Psychiatr Res. 2017 Apr;87:61-70. doi: 10.1016/j.jpsychires.2016.12.010. Epub 2016 Dec 12.
Smartphones deliver light to users through Light Emitting Diode (LED) displays. Blue light is the most potent wavelength for sleep and mood. This study investigated the immediate effects of smartphone blue light LED on humans at night. We investigated changes in serum melatonin levels, cortisol levels, body temperature, and psychiatric measures with a randomized, double-blind, cross-over, placebo-controlled design of two 3-day admissions. Each subject played smartphone games with either conventional LED or suppressed blue light from 7:30 to 10:00PM (150 min). Then, they were readmitted and conducted the same procedure with the other type of smartphone. Serum melatonin levels were measured in 60-min intervals before, during and after use of the smartphones. Serum cortisol levels and body temperature were monitored every 120 min. The Profile of Mood States (POMS), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and auditory and visual Continuous Performance Tests (CPTs) were administered. Among the 22 participants who were each admitted twice, use of blue light smartphones was associated with significantly decreased sleepiness (Cohen's d = 0.49, Z = 43.50, p = 0.04) and confusion-bewilderment (Cohen's d = 0.53, Z = 39.00, p = 0.02), and increased commission error (Cohen's d = -0.59, t = -2.64, p = 0.02). Also, users of blue light smartphones experienced a longer time to reach dim light melatonin onset 50% (2.94 vs. 2.70 h) and had increases in body temperature, serum melatonin levels, and cortisol levels, although these changes were not statistically significant. Use of blue light LED smartphones at night may negatively influence sleep and commission errors, while it may not be enough to lead to significant changes in serum melatonin and cortisol levels.
37Do blue light filter applications improve sleep outcomes? A study of smartphone users' sleep quality in an observational setting.PubMed
Marziye Rabiei, Seyed Jalil Masoumi, Masoud Haghani, et al.
Electromagn Biol Med. 2024 Apr 2;43(1-2):107-116. doi: 10.1080/15368378.2024.2327432. Epub 2024 Mar 10.
Exposure to blue light at bedtime, suppresses melatonin secretion, postponing the sleep onset and interrupting the sleep process. Some smartphone manufacturers have introduced night-mode functions, which have been claimed to aid in improving sleep quality. In this study, we evaluate the impact of blue light filter application on decreasing blue light emissions and improving sleep quality. Participants in this study recorded the pattern of using their mobile phones through a questionnaire. In order to evaluate sleep quality, we used a PSQI questionnaire. Blue light filters were used by 9.7% of respondents, 9.7% occasionally, and 80% never. The mean score of PSQI was more than 5 in 54.10% of the participants and less than 5 in 45.90%. ANOVA test was performed to assess the relationship between using blue light filter applications and sleep quality (p-value = 0.925). The findings of this study indicate a connection between the use of blue light filter apps and habitual sleep efficiency in the 31-40 age group. However, our results align only to some extent with prior research, as we did not observe sustained positive effects on all parameters of sleep quality from the long-term use of blue light filtering apps. Several studies have found that blue light exposure can suppress melatonin secretion, exacerbating sleep problems. Some studies have reported that physical blue light filters, such as lenses, can affect melatonin secretion and improve sleep quality. However, the impact of blue light filtering applications remains unclear and debatable.
38Screen Use at Bedtime and Sleep Duration and Quality Among Youths.PubMed
Bradley Brosnan, Jillian J Haszard, Kim A Meredith-Jones, et al.
JAMA Pediatr. 2024 Nov 1;178(11):1147-1154. doi: 10.1001/jamapediatrics.2024.2914.
IMPORTANCE: Although questionnaire-based cross-sectional research suggests that screen time before bed correlates with poor sleep, self-reported data seem unlikely to capture the complexity of modern screen use, requiring objective night-by-night measures to advance this field. OBJECTIVE: To examine whether evening screen time is associated with sleep duration and quality that night in youths. DESIGN, SETTING, AND PARTICIPANTS: This repeated-measures cohort study was performed from March to December 2021 in participant homes in Dunedin, New Zealand. Participants included healthy youths aged 11 to 14.9 years. Data were analyzed from October to November 2023. EXPOSURE: Objectively measured screen time, captured using wearable or stationary video cameras from 2 hours before bedtime until the first time the youth attempted sleep (shut-eye time) over 4 nonconsecutive nights. Video data were coded using a reliable protocol (κ = 0.92) to quantify device (8 options [eg, smartphone]) and activity (10 options [eg, social media]) type. MAIN OUTCOMES AND MEASURES: Sleep duration and quality were measured objectively via wrist-worn accelerometers. The association of screen use with sleep measures was analyzed on a night-by-night basis using mixed-effects regression models including participant as a random effect and adjusted for weekends. RESULTS: Of the 79 participants (47 [59.5%] male; mean [SD] age, 12.9 [1.1] years), all but 1 had screen time before bed. Screen use in the 2 hours before bed had no association with most measures of sleep health that night (eg, mean difference in total sleep time, 0 minutes [95% CI, -3 to 20 minutes] for every 10 minutes more total screen time). All types of screen time were associated with delayed sleep onset but particularly interactive screen use (mean difference, 10 minutes; 95% CI, 4 to 16 minutes for every additional 10 minutes of interactive screen time). Every 10 minutes of additional screen time in bed was associated with shorter total sleep time (mean difference, -3 minutes; 95% CI, -6 to -1 minute). The mean difference in total sleep time was -9 minutes (95% CI, -16 to -2 minutes) for every 10 minutes of interactive screen use and -4 minutes (95% CI, -7 to 0 minutes) for passive screen use. In particular, gaming (mean difference, -17 minutes; 95% CI, -28 to -7 minutes for every 10 minutes of gaming) and multitasking (mean difference, -35 minutes; 95% CI, -67 to -4 minutes on nights with vs without multitasking) were associated with less total sleep time. CONCLUSIONS AND RELEVANCE: In this repeated-measures cohort study, use of an objective method showed that screen time once in bed was associated with impairment of sleep, especially when screen time was interactive or involved multitasking. These findings suggest that current sleep hygiene recommendations to restrict all screen time before bed seem neither achievable nor appropriate.
39Sleep and Diet: Mounting Evidence of a Cyclical Relationship.PubMed
Faris M Zuraikat, Rebecca A Wood, Rocío Barragán, et al.
Annu Rev Nutr. 2021 Oct 11;41:309-332. doi: 10.1146/annurev-nutr-120420-021719. Epub 2021 Aug 4.
Two factors intrinsic to health are diet and sleep. These two behaviors may well influence one another. Indeed, that insufficient sleep adversely impacts dietary intakes is well documented. On the other hand, diet may influence sleep via melatonin and its biosynthesis from tryptophan. Experimental data exist indicating that provision of specific foods rich in tryptophan or melatonin can improve sleep quality. Whole diets rich in fruits, vegetables, legumes, and other sources of dietary tryptophan and melatonin have been shown to predict favorable sleep outcomes. Although clinical trials are needed to confirm a causal impact of dietary patterns on sleep and elucidate underlying mechanisms, available data illustrate a cyclical relation between these lifestyle factors. We recommend adopting a healthful diet to improve sleep, which may further promote sustained favorable dietary practices.
40Diet promotes sleep duration and quality.PubMed
Katri Peuhkuri, Nora Sihvola, Riitta Korpela
Nutr Res. 2012 May;32(5):309-19. doi: 10.1016/j.nutres.2012.03.009. Epub 2012 Apr 25.
Sleep, much like eating, is an essential part of life. The mechanisms of sleep are only partially clear and are the subject of intense research. There is increasing evidence showing that sleep has an influence on dietary choices. Both cross-sectional and epidemiologic studies have demonstrated that those who sleep less are more likely to consume energy-rich foods (such as fats or refined carbohydrates), to consume fewer portions of vegetables, and to have more irregular meal patterns. In this narrative review, we pose the opposite question: can ingested food affect sleep? The purpose of this review is to discuss the evidence linking diet and sleep and to determine whether what we eat and what kind of nutrients we obtain from the food consumed before bedtime matter. In addition, scientific evidence behind traditional sleep-promoting foods such as milk and some herbal products is briefly described. These are reviewed using data from clinical trials, mostly in healthy subjects. In addition, we discuss the possible mechanisms behind these observations. Lastly, we summarize our findings that emerging evidence confirms a link between diet and sleep. Overall, foods impacting the availability of tryptophan, as well as the synthesis of serotonin and melatonin, may be the most helpful in promoting sleep. Although there are clear physiological connections behind these effects, the clinical relevance needs to be studied further.
41Comprehensive effects of various nutrients on sleep.PubMed
Jaehwan Cheon, Mikyung Kim
Sleep Biol Rhythms. 2022 Aug 4;20(4):449-458. doi: 10.1007/s41105-022-00408-2. eCollection 2022 Oct.
Sleep problems have become common among people today. Sleep disorders are closely associated with physiological and psychological diseases. Among the ways of improving objective or subjective sleep quality, controlling elements associated with food intake can be more efficient than other methods in terms of time and cost. Therefore, the purpose of this study was to understand the effects of nutrients and natural products on sleep. An extensive literature search was conducted, and related articles were identified through online databases, such as Elsevier, Google Scholar, PubMed, Springer, and Web of Science. Expert opinion, conference abstracts, unpublished studies, and studies published in languages other than English were excluded from this review. The effects of macronutrients and diet adjustment on sleep differed. Although not all nutrients independently affect sleep, they comprehensively affect it through tryptophan metabolism. Furthermore, natural foods related to GABA have an effect on sleep similar to that of sleeping pills. Taken together, our results suggest that humans can control both their objective and subjective sleep quality based on their lifestyle and food consumption. However, until now, direct studies on the relationship between human sleep and nutrition, such as clinical trials, have been insufficient. As both objective and subjective sleep quality are the factors determining the quality of life of individuals, further studies on those are needed to improve it.
42Exploring the Role of Dairy Products In Sleep Quality: From Population Studies to Mechanistic Evaluations.PubMed
Marie-Pierre St-Onge, Faris M Zuraikat, Mackenzie Neilson
Adv Nutr. 2023 Mar;14(2):283-294. doi: 10.1016/j.advnut.2023.01.004. Epub 2023 Jan 31.
Poor sleep quality and insufficient sleep affect a large portion of the population. This is concerning given increasing evidence that poor sleep health is a behavioral risk factor for the development of cardiometabolic diseases. A healthy diet is associated with a plethora of favorable health outcomes, and emerging research now highlights diet as a potential determinant of sleep health that could be leveraged to improve sleep quality. Dairy products are notably rich in tryptophan (Trp), a key substrate for serotonin and melatonin production, which are instrumental for initiating and maintaining sleep. Furthermore, dairy products provide a range of micronutrients that serve as cofactors in the synthesis of melatonin from Trp, which could contribute to sleep-promoting effects. In this review, we evaluate population studies and clinical trials to examine a possible link between dairy consumption and sleep. Available epidemiologic studies illustrate positive associations between dairy intake and sleep outcomes. Moreover, some intervention studies support a causal effect of dairy intake on sleep. Given these data, we discuss potential mechanisms, invite additional clinical research on this topic, and provide insights on how limitations of current studies can be addressed in future trials.
43Effects of Diet on Sleep: A Narrative Review.PubMed
Hannah Binks, Grace E Vincent, Charlotte Gupta, et al.
Nutrients. 2020 Mar 27;12(4):936. doi: 10.3390/nu12040936.
Many processes are involved in sleep regulation, including the ingestion of nutrients, suggesting a link between diet and sleep. Aside from studies investigating the effects of tryptophan, previous research on sleep and diet has primarily focused on the effects of sleep deprivation or sleep restriction on diet. Furthermore, previous reviews have included subjects with clinically diagnosed sleep-related disorders. The current narrative review aimed to clarify findings on sleep-promoting foods and outline the effects of diet on sleep in otherwise healthy adults. A search was undertaken in August 2019 from the Cochrane, MEDLINE (PubMed), and CINAHL databases using the population, intervention, control, outcome (PICO) method. Eligible studies were classified based on emerging themes and reviewed using narrative synthesis. Four themes emerged: tryptophan consumption and tryptophan depletion, dietary supplements, food items, and macronutrients. High carbohydrate diets, and foods containing tryptophan, melatonin, and phytonutrients (e.g., cherries), were linked to improved sleep outcomes. The authors posit that these effects may be due in part to dietary influences on serotonin and melatonin activity.
44[Nutrition in improving sleep quality and fighting insomnia].PubMed
Rosa M Ortega, Ana Isabel Jiménez-Ortega, África Peral-Suárez, et al.
Nutr Hosp. 2025 Sep 11;42(Spec No1):43-46. doi: 10.20960/nh.06090.
Sleep is essential for a wide range of physiological and mental functions, but it is increasingly disturbed, which is associated with short- and long-term health damage. There are many factors involved in the deterioration of sleep quality, but from a nutritional point of view, an intake of tryptophan is useful in increasing serotonin and melatonin, but because of their competition with long-chain neutral amino acids to cross the blood-brain barrier, some proteins such as milk and eggs with high tryptophan/long-chain neutral amino acids are more useful. The adequate supply of carbohydrates and omega-3 fatty acids is favorable, while excess fat and saturated fat are harmful. In relation to vitamins, it has been shown that an adequate supply of pyridoxine, vitamin B12, folates, niacin, vitamin D and antioxidants (vitamin C, beta-carotene) help prevent sleep disturbance. In the case of minerals, various studies point to the importance of adequate iron, magnesium and zinc situation. Among the foods that are associated with benefits in sleep quality, milk and dairy products, fruits, vegetables and blue fish can be highlighted, while alcohol, energy drinks and caffeine are sleep-disrupting. Improving diet and lifestyle is a step in the fight against insomnia and improved sleep quality.
45International Society of Sports Nutrition Position Stand: Long-Chain Omega-3 Polyunsaturated Fatty Acids.PubMed
Ralf Jäger, Jeffery L Heileson, Sidney Abou Sawan, et al.
J Int Soc Sports Nutr. 2025 Dec;22(1):2441775. doi: 10.1080/15502783.2024.2441775. Epub 2025 Jan 15.
Position Statement: The International Society of Sports Nutrition (ISSN) presents this position based on a critical examination of the literature surrounding the effects of long-chain omega-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation on exercise performance, recovery, and brain health. This position stand is intended to provide a scientific foundation for athletes, dietitians, trainers, and other practitioners regarding the effects of supplemental ω-3 PUFA in healthy and athletic populations. The following conclusions represent the official position of the ISSN: Athletes may be at a higher risk for ω-3 PUFA insufficiency.Diets rich in ω-3 PUFA, including supplements, are effective strategies for increasing ω-3 PUFA levels.ω-3 PUFA supplementation, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has been shown to enhance endurance capacity and cardiovascular function during aerobic-type exercise.ω-3 PUFA supplementation may not confer a muscle hypertrophic benefit in young adults.ω-3 PUFA supplementation in combination with resistance training may improve strength in a dose- and duration-dependent manner.ω-3 PUFA supplementation may decrease subjective measures of muscle soreness following intense exercise.ω-3 PUFA supplementation can positively affect various immune cell responses in athletic populations.Prophylactic ω-3 PUFA supplementation may offer neuroprotective benefits in athletes exposed to repeated head impacts.ω-3 PUFA supplementation is associated with improved sleep quality.ω-3 PUFA are classified as prebiotics; however, studies on the gut microbiome and gut health in athletes are currently lacking.
46Effects of Omega-3 Polyunsaturated Fatty Acids Intake on Vasomotor Symptoms, Sleep Quality and Depression in Postmenopausal Women: A Systematic Review.PubMed
Ayesha Zafar Iqbal, Suet-Kei Wu, Halliru Zailani, et al.
Nutrients. 2023 Sep 30;15(19):4231. doi: 10.3390/nu15194231.
The menopausal transition is often accompanied with distressing manifestations, such as vasomotor symptoms, sleep disruptions, and depressive syndrome. Omega-3 polyunsaturated fatty acids (-3 PUFAs) have emerged as a potential intervention to alleviate these symptoms. This review aimed to comprehensively assess the impact of -3 PUFAs supplementation on vasomotor symptoms, sleep quality, and depression among postmenopausal women. We conducted a systematic literature search of randomized controlled trials across the Cochrane Library, Web of Science, PubMed, CINAHL, EMBASE, and SCOPUS databases from inception to August 2023. Among the initial pool of 163 identified studies, nine studies met the inclusion criteria and were incorporated into this systematic review. Notably, four studies detected potential benefits of -3 PUFAs in improving hot flashes and night sweats. On the contrary, sleep quality outcomes displayed heterogeneity across the studies. Incorporating diverse scales, such as the Hamilton Depression Rating Scale-21, the Patient Health Questionnaire depression scale, and Generalized Anxiety Disorder-7 for depression outcomes, we found inconclusive evidence of -3 PUFA's impact on depression. Overall, the combined analysis of these studies did not provide substantial evidence to support the efficacy of -3 PUFAs in improving vasomotor symptoms, sleep quality, and depression. Further well-designed randomized clinical trials with larger participant groups are crucial to validate and generalize these results. Review Registration: PROSPERO registration no: CRD42023421922.
47Nutritional Interventions for Enhancing Sleep Quality: The Role of Diet and Key Nutrients in Regulating Sleep Patterns and Disorders.PubMed
Rony Abou-Khalil
Food Sci Nutr. 2025 Dec 4;13(12):e71309. doi: 10.1002/fsn3.71309. eCollection 2025 Dec.
Sleep disorders and poor sleep quality are increasingly recognized as global health concerns, with substantial consequences for mental and physical health. While pharmacological treatments are available, growing evidence suggests that nutritional interventions offer effective, sustainable alternatives for enhancing sleep quality. This review aims to synthesize current evidence on the impact of key nutrients, dietary patterns, bioactive compounds, and gut microbiome modulation on sleep regulation, and to explore emerging personalized nutrition approaches for managing sleep disorders. A comprehensive review of clinical trials, observational studies, and mechanistic research published over the past two decades was conducted. Key focus areas included sleep-supportive nutrients, dietary patterns (e.g., Mediterranean, ketogenic, plant-based diets), chrononutrition, gut-brain axis modulation, functional foods, and personalized nutrition strategies. Evidence supports the role of specific nutrients (e.g., magnesium, tryptophan, omega-3 fatty acids) and dietary patterns rich in anti-inflammatory and antioxidant compounds in improving sleep outcomes. Functional foods such as tart cherry juice and kiwifruit demonstrate potential benefits. The gut microbiome emerges as a significant regulator of sleep physiology, suggesting probiotics and prebiotics as novel interventions. Personalized nutrition approaches, incorporating genetic, metabolic, and lifestyle factors, offer promising individualized solutions. Nutritional interventions represent a promising, non-pharmacological strategy for improving sleep quality and managing sleep disorders. Future research should focus on personalized approaches and large-scale clinical trials to validate and refine these strategies for clinical practice.
48Association Between Dietary Magnesium Intake and Sleep Quality in Saudi University Students: A Cross-Sectional Study.PubMed
Asma Ahmed Alshammari, Kawthar Abdullah Alsawad, Noorah Khalid Ahmed, et al.
Nat Sci Sleep. 2025 Dec 16;17:3127-3136. doi: 10.2147/NSS.S569883. eCollection 2025.
PURPOSE: Background: Sleep is essential for both physical and cognitive functioning. Magnesium, a vital mineral, plays a key role in sleep regulation. Adequate sleep and sufficient magnesium intake are critical for university students' overall well-being, academic performance, and long-term health. This study aimed to investigate the association between dietary magnesium intake and sleep quality in university students in Saudi Arabia. METHODS: An analytic cross-sectional study was conducted using an electronic questionnaire distributed to 1206 university students in the Eastern Province of Saudi Arabia via social media. Data were collected from December 2023 to March 2024 over a 3-month period. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and magnesium intake was evaluated using a magnesium food frequency questionnaire (MgFFQ). RESULTS: Of 1206 participants, 305 met the inclusion criteria, of which 69% were female. A significant association was observed between shorter sleep duration (<5 h) and lower monthly magnesium intake (p = 0.008). Daytime dysfunction was also significantly associated with a low monthly magnesium intake (p = 0.009). The median PSQI score was significantly higher in females than males (p = 0.038). CONCLUSION: Higher dietary magnesium intake was associated with better sleep quality, longer sleep duration, and reduced daytime dysfunction, highlighting the potential benefits of magnesium-rich diets for sleep health. Importantly, a significant sex disparity was observed in this university cohort, where females demonstrated poorer sleep quality than males. Therefore, dietary awareness programs that promote magnesium-rich food sources should be incorporated into student health initiatives to support improved sleep quality.
49From Garden to Pillow: Understanding the Relationship between Plant-Based Nutrition and Quality of Sleep.PubMed
Neslihan Arslan, Eda Bozkır, Tevfik Koçak, et al.
Nutrients. 2024 Aug 13;16(16):2683. doi: 10.3390/nu16162683.
The effect of diet on sleep quality has been addressed in many studies; however, whether/how plant-based diets (PBDs) impact sleep-related parameters has not been explored in detail. This review aims to give an overview of the components of PBDs and the possible mechanisms through which PBDs may improve sleep quality. Studies have indicated that diets such as PBDs, which are typically high in fruits, vegetables, nuts, seeds, whole grains, and fiber, are associated with better sleep outcomes, including less fragmented sleep and improved sleep duration. Several mechanisms may explain how PBDs impact and/or improve sleep outcomes. Firstly, PBDs are characteristically rich in certain nutrients, such as magnesium and vitamin B6, which have been associated with improved sleep patterns. Secondly, PBDs are often lower in saturated fats and higher in fiber, which may contribute to better overall health, including sleep quality. Additionally, plant bioactive compounds like phytochemicals and antioxidants in fruits, vegetables, and herbs may have sleep-promoting effects. According to available data, PBD and Mediterranean diet elements promise to enhance sleep quality; however, it is crucial to note that diets should be customized based on each person's needs.
50Higher daytime intake of fruits and vegetables predicts less disrupted nighttime sleep in younger adults.PubMed
Hedda L Boege, Katherine D Wilson, Jennifer M Kilkus, et al.
Sleep Health. 2025 Oct;11(5):590-596. doi: 10.1016/j.sleh.2025.05.003. Epub 2025 Jun 11.
BACKGROUND: Higher-quality diets are associated with better sleep quality in observational studies. However, a better understanding of this association is needed given that dietary modifications could represent a novel and natural approach to achieve better sleep. OBJECTIVE: To examine how daytime dietary intakes influence sleep quality on the following night using multiple days of self-reported diet monitoring and objective sleep measured under free-living conditions. METHODS: Participants were younger US adults with average habitual sleep duration between 7 and 9 hours per night. Diet was assessed using the Automated Self-Administered 24-Hour Dietary Assessment Tool. Sleep was measured using wrist actigraphy. Sleep fragmentation index was used for objective assessment of sleep quality. RESULTS: Thirty-four participants (age: 28.3±6.6years, BMI: 24.1±3.9 kg/m, 82.3% males, 50.0% racial/ethnic minority) provided 201 paired diet-sleep data. Greater daytime intakes of fruits and vegetables (β-coefficient (SE)=-0.60 (0.29), P=.038) and carbohydrates (-0.02 (0.007), P=.022), but not added sugar (P=.54), were associated with lower sleep fragmentation index. Trends toward associations of higher intakes of red and processed meat (P=.10) with more disrupted sleep, as well as higher fiber (P=.08) and magnesium (P=.09) intakes with less disrupted sleep, were observed. CONCLUSIONS: Higher daytime intakes of fruits and vegetables and carbohydrates that align with a healthy diet were associated with less disrupted nighttime sleep. A 5-cup increase (from no intake) in fruits and vegetables, meeting dietary recommendations, was associated with 16% better sleep quality. These findings suggest that diets rich in complex carbohydrates, fruits, and vegetables may promote better sleep health. CLINICAL TRIAL REGISTRY: NCT03663530 and NCT03257137.
51Sleep, alcohol, and caffeine in financial traders.PubMed
Frank Song, Matthew P Walker
PLoS One. 2023 Nov 8;18(11):e0291675. doi: 10.1371/journal.pone.0291675. eCollection 2023.
Alcohol and caffeine are two of the most commonly used substances for altering human consciousness. While their adverse effects on sleep have been separately examined in the laboratory and epidemiological levels, how they impact real-world night-to-night sleep, in isolation or together, remains unclear. This is especially true in occupations wherein the use of alcohol and caffeine is high (e.g., financial services sector). Using a six-week micro-longitudinal study, here we examined the real-world impact of alcohol, caffeine, and their combined consumption in a cohort of financial traders. We demonstrate that alcohol consumption significantly degrades the subjective quality of sleep (p < 0.001). Caffeine consumption led to a different phenotype of sleep impairment, resulting in a detrimental reduction in sleep quantity (p = 0.019), rather than a marked alteration in sleep quality. Contrary to our hypothesis, when consumed in combination, evening alcohol consumption interacted with ongoing caffeine consumption such that alcohol partially mitigated the impairments in sleep quantity associated with caffeine (p = 0.032). This finding suggests the sedating effects of alcohol and the psychoactive stimulant effects of caffeine obscure each other's impact on sleep quantity and sleep quality, respectively-potentially explaining their interdependent use in this cohort (i.e., "self-medication" of evening sedation with alcohol to combat the prior daytime ingestion of caffeine and vice versa). More generally, these results contribute to a unique understanding of the singular and combinatory impacts of two of the most commonly used substances for augmenting human consciousness under free-living, real-world conditions, the performance-impairing (and thus economic-cost) consequences of which may be important to the business sector and the society.
52Caffeine Delays Ethanol-Induced Sedation in .PubMed
Sonia Tremblay, Yanqiqi Zeng, Aixin Yue, et al.
Biology (Basel). 2022 Dec 30;12(1):63. doi: 10.3390/biology12010063.
Caffeine and ethanol are among the most widely available and commonly consumed psychoactive substances. Both interact with adenosine receptor-mediated signaling which regulates numerous neurological processes including sleep and waking behaviors. In mammals, caffeine is an adenosine receptor antagonist and thus acts as a stimulant. Conversely, ethanol is a sedative because it promotes GABAergic neurotransmission, inhibits glutamatergic neurotransmission, and increases the amount of adenosine in the brain. Despite seemingly overlapping interactions, not much is known about the effect of caffeine on ethanol-induced sedation in . In this study, using as a model, we show that caffeine supplementation in food delays the onset of ethanol-induced sedation in males and females of different strains. The resistance to sedation reverses upon caffeine withdrawal. Heterozygous adenosine receptor mutant flies are resistant to sedation. These findings suggest that caffeine and adenosine receptors modulate the sedative effects of ethanol in .
53Interaction between sleep quality and dietary inflammation on frailty: NHANES 2005-2008.PubMed
Mengzi Sun, Ling Wang, Xuhan Wang, et al.
Food Funct. 2023 Jan 23;14(2):1003-1010. doi: 10.1039/d2fo01832b.
: The underlying mechanism of both sleep disorders and frailty is chronic inflammation, which can be reflected by the dietary inflammatory index (DII). Therefore, we aimed to explore the association between sleep quality, frailty, and dietary inflammation. : 9007 participants aged over 20 years from the National Health and Nutrition Examination Survey (NHANES) in 2005-2008 were involved in the study. Dietary inflammation was assessed by DII, sleep quality was assessed by the Pittsburgh sleep quality index (PSQI), and frailty was assessed by the 36-item frailty index (FI). Logistic regression, stratified analysis of sub-groups, and forest plots were used in this study. : Both pro-inflammatory diet and poor sleep quality were risk factors for frailty. There was an interaction between dietary inflammation and sleep quality (-interaction = 0.003). Pro-inflammatory diet was associated with increased risk of frailty among the population with poor sleep quality. Compared with the anti-inflammatory diet and good sleep quality group, the OR of frailty was 1.44 (1.21, 1.73) and 2.16 (1.64, 2.80) for the anti-inflammatory diet and poor sleep quality and pro-inflammatory diet and poor sleep quality groups, respectively. : There was an interaction between dietary inflammation and sleep quality on frailty. Anti-inflammatory diet may attenuate the detrimental impacts of poor sleep quality on frailty.
54Diet Composition and Objectively Assessed Sleep Quality: A Narrative Review.PubMed
Katherine Wilson, Marie-Pierre St-Onge, Esra Tasali
J Acad Nutr Diet. 2022 Jun;122(6):1182-1195. doi: 10.1016/j.jand.2022.01.007. Epub 2022 Jan 19.
Insufficient sleep is highly prevalent in society and has tremendous negative health consequences. Despite the available treatments, there is continued demand for novel and natural strategies to promote better sleep. Dietary modifications could be a viable new target to improve sleep. A literature review using PubMed was conducted on studies that examined the relationship between diet composition (ie, macronutrients or special diets) and objectively assessed sleep quality. Twenty human studies (6 observational and 14 interventional) published between 1975 and March 2021 met the eligibility criteria and were included. The amount of dietary carbohydrates and fats was associated with both better and worse sleep quality indices. However, the type of carbohydrate and fat was an important factor in these associations, with diets higher in complex carbohydrates (eg, fiber) and healthier fats (eg, unsaturated) being associated with better sleep quality. Diets higher in protein were associated with better sleep quality. In general, diets rich in fiber, fruits, vegetables, and anti-inflammatory nutrients and lower in saturated fat (eg, Mediterranean diet) were associated with better sleep quality. The connection between diet and sleep quality warrants further investigation. Rigorous interventional studies of longer duration assessing the effects of whole foods, rather than isolated nutrients, and under free-living conditions, rather than in a research laboratory setting, as well as mechanistic studies are needed to better understand how dietary patterns relate to sleep quality. Future research could provide insights into whether dietary modifications could be an effective, personalized strategy for improving sleep quality in millions of Americans.
55The effect of resistance exercise on sleep: A systematic review of randomized controlled trials.PubMed
Ana Kovacevic, Yorgi Mavros, Jennifer J Heisz, et al.
Sleep Med Rev. 2018 Jun;39:52-68. doi: 10.1016/j.smrv.2017.07.002. Epub 2017 Jul 19.
Impaired sleep quality and quantity are associated with future morbidity and mortality. Exercise may be an effective non-pharmacological intervention to improve sleep, however, little is known on the effect of resistance exercise. Thus, we performed a systematic review of the literature to determine the acute and chronic effects of resistance exercise on sleep quantity and quality. Thirteen studies were included. Chronic resistance exercise improves all aspects of sleep, with the greatest benefit for sleep quality. These benefits of isolated resistance exercise are attenuated when resistance exercise is combined with aerobic exercise and compared to aerobic exercise alone. However, the acute effects of resistance exercise on sleep remain poorly studied and inconsistent. In addition to the sleep benefits, resistance exercise training improves anxiety and depression. These results suggest that resistance exercise may be an effective intervention to improve sleep quality. Further research is needed to better understand the effects of acute resistance exercise on sleep, the physiological mechanisms underlying changes in sleep, the changes in sleep architecture with chronic resistance exercise, as well its efficacy in clinical cohorts who commonly experience sleep disturbance. Future studies should also examine time-of-day and dose-response effects to determine the optimal exercise prescription for sleep benefits.
56Comparative efficacy of exercise regimens on sleep quality in older adults: A systematic review and network meta-analysis.PubMed
Faizul Hasan, Yu-Kang Tu, Chih-Ming Lin, et al.
Sleep Med Rev. 2022 Oct;65:101673. doi: 10.1016/j.smrv.2022.101673. Epub 2022 Aug 27.
The efficacies of various exercise modalities in improving older adults' sleep quality remain unclear. Therefore, in this study, network meta-analysis was performed by comparing the efficacies of various exercise regimens in improving sleep quality in this age group. Six electronic databases were searched for relevant studies between the date of database creation and August 13, 2021. Only randomized controlled trials reporting the effects of exercise on sleep quality in this population were included. Random-effects network meta-analysis based on a frequentist framework was conducted. In total, 35 trials involving 3519 older adults were included. Cognitive behavioral therapy for insomnia, muscle endurance training combined with walking, Tai chi, Baduanjin, resistance training combined with walking, and resistance training significantly improved sleep quality to a greater degree than did usual care (P < 0.05). Muscle endurance training combined with walking led to significantly higher sleep quality than did regimens involving sleep hygiene, Pilates, only walking, health education, resistance training, Taichi, resistance training combined with walking, or yoga. Muscle endurance training combined with walking was identified as the optimal exercise program (88.9%) for enhancing sleep quality in older adults. The results of this study support the claim that exercise can improve sleep quality in this population. PROSPERO registration number: CRD42020178209.
57A randomized controlled trial of the effect of exercise on sleep.PubMed
N A Singh, K M Clements, M A Fiatarone
Sleep. 1997 Feb;20(2):95-101. doi: 10.1093/sleep/20.2.95.
We tested the hypothesis that exercise would improve subjective sleep quality and activity in depressed elders. A 10-week randomized controlled trial was utilized. Participants consisted of a volunteer sample, aged > 60 with a diagnosis of major or minor depression or dysthymia. A total of 32 subjects aged 60-84 years with a mean age of 71.3 +/- 1.2 years was used. Intervention consisted of a supervised weight-training program three times a week or an attention-control group. Main outcome measures were Pittsburgh Subjective Sleep Quality Index (PSQI), Likert Scale of Subjective Sleep Quality and Quantity. Paffenbarger Activity Index. Geriatric Depression Scale (GDS). Beck Depression Inventory (BDI), Hamilton Rating Scale of Depression (HRSD), and the Medical Outcomes Survey Short Form 36 (SF-36). Results showed that exercise significantly improved all subjective sleep-quality and depression measures. Depression measures were reduced by approximately twice that of controls. Habitual activity was not significantly increased by exercise. Quality of life subscales significantly improved. In a forward stepwise multiple regression, percent improvement in GDS and percent increase in strength remained significant predictors of the improvement in total PSQI score (r = 0.71, p = 0.0002). In conclusion, weight lifting exercise was effective in improving subjective sleep quality, depression, strength, and quality of life without significantly changing habitual activity.
58Exercise and Nutrition in the Mental Health of the Older Adult Population: A Randomized Controlled Clinical Trial.PubMed
María Del Carmen Carcelén-Fraile, Noelia Del Pino Déniz-Ramírez, Jessica Sabina-Campos, et al.
Nutrients. 2024 Jun 1;16(11):1741. doi: 10.3390/nu16111741.
(1) Background: Global population aging is changing demographic structures and presents significant challenges for health systems, which must adapt to an increasingly elderly population. (2) Methods: The study employed a randomized controlled trial design with a total of 116 older adults aged 65 or older, randomly assigned to an experimental group ( = 57) undergoing a combined resistance program and Mediterranean diet program and a control group ( = 59) who did not receive any intervention. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS), sleep quality through the Pittsburgh Sleep Quality Index (PSQI), and perceived stress using the Perceived Stress Scale (PSS). (3) Results: Statistically significant improvements ( < 0.05) were observed both within and between groups in anxiety (Cohen's d = 0.38 and 0.78, respectively), depression (Cohen's d = 0.56 and 0.18, respectively), perceived stress (Cohen's d = 0.15 and 0.39, respectively), and in the PSQI domains: subjective sleep quality (Cohen's d = 1.01 and 0.53, respectively), sleep duration (Cohen's d = 0.112 and 0.53, respectively), sleep disturbances (Cohen's d = 1.92 and 0.95, respectively), use of medications (Cohen's d = 0.34 and 0.40, respectively), and the PSQI total score (Cohen's d = 0.68 and 0.49, respectively). No significant differences were observed in sleep latency or daytime dysfunction. (4) Conclusions: The results of the present study suggest that resistance intervention may be an effective therapeutic option to improve mental health and sleep quality in older adults aged 65 or older, offering a non-pharmacological approach to improving overall well-being in this demographic.
59Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials.PubMed
Pakwan Bahalayothin, Kittiphon Nagaviroj, Thunyarat Anothaisintawee
Fam Med Community Health. 2025 Mar 4;13(1):e003056. doi: 10.1136/fmch-2024-003056.
OBJECTIVE: To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most. STUDY SELECTION: Eligible randomised controlled trials that compare physical exercise to routine activities, usual care, non-physical activity, or health education to measure the Pittsburgh Sleep Quality Index. DATA SOURCE: Studies retrieved from Medline, Embase, CINAHL, Scopus, ClinicalTrial.gov and ThaiJo from the database's inception to October 2022. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently identified studies, collected data and assessed bias. In the absence of heterogeneity, a fixed effect model was used for pairwise meta-analysis. Alternatively, a random effect model was used. A two-stage network meta-analysis used the surface under the cumulative ranking curve (SUCRA) to compare exercise efficacy. MAIN OUTCOME: Global Pittsburgh Sleep Quality Index (GPSQI) and subdomain score. RESULTS: This review comprised 2170 people from 25 trials. Direct meta-analysis revealed significant improvement in GPSQI with combined exercise (unstandardised mean difference (USMD) -2.35, 95% CI-3.13 to -1.57, p<0.001, I=69.13%). GPSQI decreased considerably with aerobic activity (USMD -4.36, 95% CI -7.86 to -0.86, p=0.01, I=97.83%). For the network meta-analysis, strengthening, aerobic and combination exercise significantly lowered GPSQI (USMD-5.75, -3.76 and -2.54, respectively). Strength training improved GPSQI scores most effectively (SUCRA 94.6%). CONCLUSION: Exercise that strengthens muscles, rather than aerobic or combination exercises, is the most effective way to enhance sleep quality.
60Relationship Between Obstructive Sleep Apnea and Sports-Systematic Review and Meta-Analysis.PubMed
Lucía Martínez Revuelta, Javier Flores-Fraile, Álvaro Zubizarreta-Macho, et al.
J Clin Med. 2024 Nov 13;13(22):6814. doi: 10.3390/jcm13226814.
The primary objective of this research is to analyze and compare the effects of physical activity on patients diagnosed with obstructive sleep apnea (OSA), a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and various health complications. A systematic and strategic search of 16 peer-reviewed articles was conducted to assess the impact of different types of physical exercise on the apnea-hypopnea index (AHI), a key metric used to quantify the severity of OSA. The selected studies focused on two main exercise modalities: aerobic exercise alone and a combination of aerobic and resistance training. These modalities were examined to determine their respective influences on the AHI among individuals with OSA. The findings revealed that aerobic exercise alone did not significantly alter the apnea-hypopnea index ( = 0.15), suggesting limited effectiveness in reducing the severity of OSA when performed in isolation. However, in patients who engaged in combined physical activity-incorporating both aerobic and resistance exercises-a significant reduction in the AHI was observed ( < 0.01), indicating a more substantial therapeutic effect. This study concludes that a structured exercise program combining aerobic and resistance training produces a significant improvement in the apnea-hypopnea indices of patients with obstructive sleep apnea. These results highlight the potential of combined exercise regimens as a non-pharmacological intervention that could complement traditional OSA treatments, offering a viable approach to managing the condition and improving patient outcomes. Future research should aim to explore the optimal exercise intensity, duration, and frequency to maximize these benefits.
61The effects of physical activity on sleep: a meta-analytic review.PubMed
M Alexandra Kredlow, Michelle C Capozzoli, Bridget A Hearon, et al.
J Behav Med. 2015 Jun;38(3):427-49. doi: 10.1007/s10865-015-9617-6. Epub 2015 Jan 18.
A significant body of research has investigated the effects of physical activity on sleep, yet this research has not been systematically aggregated in over a decade. As a result, the magnitude and moderators of these effects are unclear. This meta-analytical review examines the effects of acute and regular exercise on sleep, incorporating a range of outcome and moderator variables. PubMed and PsycINFO were used to identify 66 studies for inclusion in the analysis that were published through May 2013. Analyses reveal that acute exercise has small beneficial effects on total sleep time, sleep onset latency, sleep efficiency, stage 1 sleep, and slow wave sleep, a moderate beneficial effect on wake time after sleep onset, and a small effect on rapid eye movement sleep. Regular exercise has small beneficial effects on total sleep time and sleep efficiency, small-to-medium beneficial effects on sleep onset latency, and moderate beneficial effects on sleep quality. Effects were moderated by sex, age, baseline physical activity level of participants, as well as exercise type, time of day, duration, and adherence. Significant moderation was not found for exercise intensity, aerobic/anaerobic classification, or publication date. Results were discussed with regards to future avenues of research and clinical application to the treatment of insomnia.
62Enhancing performance through biochemical monitoring and nutritional support in female weightlifters during pre-competition weight reduction: a randomized trial.PubMed
Liang Yu, Liang Cheng
J Int Soc Sports Nutr. 2024 Dec;21(1):2435542. doi: 10.1080/15502783.2024.2435542. Epub 2024 Nov 28.
OBJECTIVE: Weight reduction is a common practice among female weightlifters before competitions to qualify for specific weight classes. However, this process can adversely affect their physical performance and health. This study aimed to investigate the impact of physiological and biochemical monitoring and nutritional support on the competitive state of female weightlifters during the pre-competition weight reduction period. METHODS: A randomized controlled trial was conducted with 28 female weightlifters from Sichuan Province, China, randomly assigned to the experimental group ( = 14) or the control group ( = 14). Both groups followed their regular training schedules. The experimental group received personalized nutritional monitoring and supplementation, including detailed assessments, dietary logs, weekly consultations, and targeted supplements based on biochemical indicators and training needs. The control group continued with their standard diet and training without additional interventions. Serum indicators, fatigue scales, and Pittsburgh Sleep Quality Index (PSQI) scores were monitored (a total of 5 tests). RESULTS: The experimental group exhibited a significant reduction in creatine kinase levels by the fourth week compared to both baseline and the first week ( < 0.05), and maintained higher levels of testosterone, testosterone/cortisol ratio, and hemoglobin than the control group from the second week onwards ( < 0.05). Conversely, the control group showed an increase in creatine kinase and a decrease in testosterone and testosterone/cortisol ratio over the same period ( < 0.05). By the fourth week, the experimental group also reported lower fatigue and better sleep quality, as indicated by lower PSQI scores, compared to the control group ( < 0.001). CONCLUSION: Personalized nutritional supplementation has an improving effect on biochemical indicators, fatigue, and sleep quality in female weightlifters during the pre-competition weight reduction period. Implementing biochemical monitoring and personalized nutritional support during this period is a key strategy for enhancing the competitive performance of female weightlifters.
63Quiet Time Improves the Patient Experience.PubMed
Christine Hedges, Candice Hunt, Pamela Ball
J Nurs Care Qual. 2019 Jul/Sep;34(3):197-202. doi: 10.1097/NCQ.0000000000000363.
BACKGROUND: A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff. LOCAL PROBLEM: Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study. METHODS: A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for quiet time (QT) and used HCAHPS "always quiet" scores as the primary outcome measure. INTERVENTIONS: The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. RESULTS: Quiet scores improved on both units after 11 months. CONCLUSIONS: Noise in hospitals is often beyond the scope of nurse-driven improvement; however, a QT protocol led by nurses, developed by multiple stakeholders, and focused on changing expectations for quiet can lead to measurable improvements in patient perception of quiet.
64The use of entertainment and communication technologies before sleep could affect sleep and weight status: a population-based study among children.PubMed
Nomathemba Dube, Kaviul Khan, Sarah Loehr, et al.
Int J Behav Nutr Phys Act. 2017 Jul 19;14(1):97. doi: 10.1186/s12966-017-0547-2.
BACKGROUND: Short sleep duration and poor sleep quality have been demonstrated to be associated with childhood obesity. It has been suggested that electronic entertainment and communication devices (EECDs) including TVs, computers, tablets, video games and cell phones interfere with sleep in children and youth. The aim of this study was to assess the impact that the use of EECDs in the hour before bedtime has on sleep and weight status to inform sleep promotion interventions and programs to prevent childhood obesity. METHODS: A provincially representative sample of 2334 grade 5 children and their parents in Alberta, Canada was surveyed. Parents reported their child's bedtime and wake-up time along with how often their child snored, felt sleepy during the day, woke-up at night and woke-up in the morning feeling unrefreshed. Sleep duration, sleep quality and sleep efficiency were derived from these indicators. Parents also reported on the presence of EECDs in their child's bedroom, while children reported use of EECDs during the day and frequency of using each of these devices during the hour before sleep. The height and weight of children were measured. Multivariable mixed effect linear and logistic regression models were used to determine how sleep duration, sleep quality, sleep efficiency and weight status are influenced by (i) access to EECDs in children's bedrooms, (ii) use of EECDs during the hour before sleep, and (iii) calming activities specifically reading during the hour before sleep. RESULTS: Sleep duration was shorter by -10.8 min (cell phone), -10.2 min (computer) and -7.8 min (TV) for those with bedroom access to and used these EECDs during the hour before sleep compared to no access and no use. Good sleep quality was hindered by bedroom access to and use of all EECDs investigated during the hour before sleep, particularly among users of cell phones (OR = 0.64, 95% CI: 0.58-0.71) and computers (OR = 0.72, 95% CI: 0.65-0.80). Very good sleep efficiency was decreased by access to and frequent use of a TV (54%), cell phone (52%), tablet (51%) and video games (51%). Odds of obesity were doubled by bedroom access to and use of a TV and computer during the hour before sleep. Children who rarely read a printed book in the bedroom during the hour before sleep had a shorter sleep duration and poorer sleep quality and sleep efficiency compared to their peers. Having access to an EECD in the bedroom was associated with increased obesity despite frequently reading during the hour before sleep. CONCLUSIONS: Our findings suggest that sleep duration, sleep quality, sleep efficiency and weight status are better among children who do not have EECDs in the bedroom and frequently read a book during the hour before sleep as opposed to those who use EECDs during this hour. Education of limits against EECD use by parents may improve sleep outcomes. These findings will inform health promotion messages and may give rise to national recommendations regarding EECD use. TRIAL REGISTRATION: ClinicalTrials.gov NCT01914185 . Registered 31 July 2013 Retrospectively registered.
65The efficacy of progressive muscle relaxation training on cancer-related fatigue and quality of life in patients with cancer: A systematic review and meta-analysis of randomized controlled studies.PubMed
Yajiao Wang, Liu Yang, Guijiao Lin, et al.
Int J Nurs Stud. 2024 Apr;152:104694. doi: 10.1016/j.ijnurstu.2024.104694. Epub 2024 Jan 12.
BACKGROUND: Cancer-related fatigue is one of the most common symptoms in cancer patients, usually accompanied by anxiety, depression and insomnia, which seriously affect patients' quality of life. Progressive muscle relaxation training is widely used for cancer-related fatigue, but the overall effect is unclear. OBJECTIVES: The aim of this study was to summarize the evidence on the effects of progressive muscle relaxation training on cancer-related fatigue and quality of life in cancer patients. DESIGN: Systematic review and meta-analysis. METHODS: Nine electronic databases (PubMed, Excerpta Medica Database (Embase), The Cochrane Library (Cochrane Central Register of Controlled Trials, CENTRAL), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang Database) were explored for randomized controlled trials (RCTs) published before February 2023. This study was reported based on the PRISMA 2020 statement. The Cochrane Collaboration's risk of bias assessment tool was used for methodological assessment, and the GRADE pro online assessment tool was used for evidence evaluation. The data were analyzed with the Review Manager 5.4 software. RESULTS: Twelve studies involving 1047 patients were included. Meta-analysis showed that progressive muscle relaxation training plus routine nursing produced more positive effects than routine nursing in improving cancer-related fatigue [SMD = -1.06, 95 % CI -1.49, -0.62, P < 0.00001], anxiety [SMD = -1.09, 95 % CI -1.40, -0.77, P < 0.00001], depression [SMD = -1.43, 95 % CI -1.76, -1.10, P < 0.00001], and quality of sleep [MD = -1.41, 95 % CI -1.74, -1.08, P < 0.00001]. However, there was no significant difference in improving quality of life [SMD = 0.27, 95 % CI -0.62, 1.15, P = 0.55]. Progressive resistance exercise plus routine nursing improved cancer-related fatigue more than progressive muscle relaxation training plus routine nursing [SMD = 1.11, 95 % CI 0.43, 1.78, P = 0.001]. There was low certainty of evidence that progressive muscle relaxation training improved cancer-related fatigue and quality of sleep, and the evidence that improved quality of life, anxiety and depression was very low. CONCLUSION: Current evidence suggested that progressive muscle relaxation training has the potential to improve cancer-related fatigue, anxiety, depression and quality of sleep in patients with cancer and is a low-load, simple exercise worthy of recommendation for cancer patients in fatigue state. Future research should focus on improving the methodological quality of randomized controlled trials to enhance the persuasive evidence of progressive muscle relaxation training efficacy.
66Effectiveness of Progressive Muscle Relaxation and Deep Breathing Exercise on Pain, Disability, and Sleep Among Patients With Chronic Tension-Type Headache: A Randomized Control Trial.PubMed
Lakshmanan Gopichandran, Achal Kumar Srivastsava, P Vanamail, et al.
Holist Nurs Pract. 2024;38(5):285-296. doi: 10.1097/HNP.0000000000000460. Epub 2024 Aug 16.
A randomized control trial was conducted to assess the effectiveness of progressive muscle relaxation and deep breathing exercises on pain, disability, and sleep quality among patients with chronic tension-type headache. Of the 169 randomly selected patients, 84 performed the intervention and reported less pain severity and disability and better sleep quality after 12 weeks.
67The Effect of Music and Eye Masks on Sleep Quality and Delirium in Abdominal Surgery Intensive Care Patients: Randomized Controlled Trial.PubMed
Tuğçe Topal, Yeliz Sürme
Nurs Crit Care. 2025 Jul;30(4):e70072. doi: 10.1111/nicc.70072.
BACKGROUND: Postoperative delirium is a negative surgical outcome that can affect patients of any age, from children to elderly. AIM: This study evaluated the impact of eye masks and music on sleep quality and delirium among patients in surgical intensive care units. STUDY DESIGN: This study was designed as a randomized controlled trial. The study sample consisted of 45 patients (21 intervention and 24 control) who were hospitalized in the General Surgery Intensive Care Unit, underwent abdominal surgery and met the inclusion criteria. Patients were assigned to the experimental and control groups by simple randomization method. Patient Identification Form, Richard-Campbell Sleep Questionnaire (RCSQ), Nursing Delirium Screening Scale (Nu-DESC) and Richmond Agitation-Sedation Scale (RASS) were utilized. In the intervention group, patients were left with the eye masks applied after 22:00. Concurrently with the application of the eye masks, calming classical music was played for 1 h. Descriptive statistics, Chi-square test, Student's t-test, one-way analysis of variance (ANOVA), two-way repeated measures ANOVA and linear regression analysis were used. The CONSORT checklist was used in reporting the study. RESULTS: On the third day of the study, the mean RCSQ score in the intervention group was statistically higher (72.95 ± 7.47, 49.66 ± 10.80; p < 0.001). The intervention group's mean Nu-DESC score was 0.14 ± 0.35, and the control group's score was 0.83 ± 0.56 (p < 0.001). Additionally, throughout the study, no delirium was observed in the intervention group, while delirium developed in 8.3% of the control group. A significant positive relationship was found between the application of music and eye masks post-surgery and the difference in RCSQ scores (zβ: 0.843; p < 0.001; [95% CI: 0.027; 0.041]). A significant negative relationship was found between the application of music and eye masks post-surgery and the difference in Nu-DESC delirium scale scores (zβ: -0.579; p < 0.001; [95% CI: -0.593; -0.234]). CONCLUSION: The research concluded that listening to calming music for 1 h daily and wearing an eye mask before sleeping increased sleep quality and decreased the incidence of delirium. RELEVANCE TO CLINICAL PRACTICE: Intensive care nurses can contribute to improving patients' sleep quality and preventing delirium by applying eye masks and playing music for the patients.
68Nurse-led evidence-based quality improvement programme to improve intensive care unit patient sleep quality.PubMed
Weidi Wang, Xinyan Cao, Jiabin Luan, et al.
Nurs Crit Care. 2025 May;30(3):e70028. doi: 10.1111/nicc.70028.
BACKGROUND: Patients in the intensive care unit (ICU) suffer from significant sleep disturbances, which can negatively impact their healing and overall health. Nurses, as the primary caregivers, need to have expertise in sleep management to ensure better patient outcomes. Implementing nurse-led, evidence-based sleep protocols in ICUs is crucial. AIM: This study aimed to improve ICU patients' sleep quality by developing and implementing a nurse-led, evidence-based SLEEP Bundle, including Sleep initiative, Light control, Eye mask and earplugs usage, Environment noise cancellation and Provision of non-pharmacological (aromatherapy and music therapy) and pharmacological (dexmedetomidine and painkillers) support. METHODS: The Framework of Evidence-based Continuous Quality Improvement and the Ottawa Model of Research Use framework were used to guide the development, implementation and assessment of the SLEEP Bundle. A quasi-experimental study was conducted in a 12-bed surgical intensive care unit (SICU), assessing patient-perceived sleep quality, nurses' self-report knowledge, attitudes and actions regarding patient sleep conditions and nurses' adherence to the interventions. INTERVENTIONS: In order to successfully translate evidence into clinical practice, the protocol was crafted with significant nurse involvement, input in sleep promotion materials and a flexible continuing education component, which provided credits to encourage nurse participation. A sleep-aid kit, complete with non-pharmacological tools, and a system of regular quality control and feedback were integral to the clinical application of the protocol. RESULTS: The intervention significantly enhanced ICU patients' sleep quality, as evidenced by a significant increase in Richards-Campbell Sleep Questionnaire scores from 62 (IQR = 48-72) to 70 (IQR = 62-76) (95% CI [-10.000, -6.000], Z = -6.100, p < .001). Nurses demonstrated a 100% agreement in knowledge items and a significant upsurge in action items following the intervention. Concurrently, adherence to practice standards showed notable improvements in sleep management practices, including enhanced sleep quality assessment, daytime functional exercise support and compliance with environmental regulations, along with increased use of earplugs, eye masks and aromatherapy/music therapy. CONCLUSIONS: The study highlights the effectiveness and feasibility of a nurse-led sleep management strategy, as demonstrated by improved patient outcomes and increased nurse adherence to sleep promotion interventions. RELEVANCE TO CLINICAL PRACTICE: The significant improvements in sleep quality as well as the increased adherence to evidence-based interventions by nurses suggest that this SLEEP Bundle could be effectively translated to other clinical settings.
69Benefits of a bedtime routine in young children: Sleep, development, and beyond.PubMed
Jodi A Mindell, Ariel A Williamson
Sleep Med Rev. 2018 Aug;40:93-108. doi: 10.1016/j.smrv.2017.10.007. Epub 2017 Nov 6.
This paper presents a conceptual model and reviews the empirical evidence to support a nightly bedtime routine as a key factor in the promotion of not only healthy sleep, but also of broad development and wellbeing in early childhood. A bedtime routine embodies the characteristics of nurturing care and early child stimulation, which are deemed to be essential for positive outcomes, especially for at-risk children. Furthermore, common, adaptive components of a bedtime routine can contribute to an array of positive developmental outcomes beyond improved sleep, inclusive of language development, literacy, child emotional and behavioral regulation, parent-child attachment, and family functioning, among other outcomes. These bedtime routine components include activities in the broad domains of nutrition (e.g., feeding, healthy snack), hygiene (e.g., bathing, oral care), communication (e.g., reading, singing/lullabies) and physical contact (e.g., massage, cuddling/rocking). A bedtime routine can provide multiple benefits to child and family functioning at a time of day that many parents are present with their children. Although additional research on hypothesized routine-related child outcomes and mechanisms of action are needed, promoting a bedtime routine may be a feasible and cost-effective method to promote positive early childhood development worldwide, particularly for socioeconomically disadvantaged and other at-risk young children.
70Sleep Regulation, Physiology and Development, Sleep Duration and Patterns, and Sleep Hygiene in Infants, Toddlers, and Preschool-Age Children.PubMed
Eleanor Bathory, Suzy Tomopoulos
Curr Probl Pediatr Adolesc Health Care. 2017 Feb;47(2):29-42. doi: 10.1016/j.cppeds.2016.12.001. Epub 2017 Jan 20.
Sleep problems are common, reported by a quarter of parents with children under the age of 5 years, and have been associated with poor behavior, worse school performance, and obesity, in addition to negative secondary effects on maternal and family well-being. Yet, it has been shown that pediatricians do not adequately address sleep in routine well-child visits, and underdiagnose sleep issues. Pediatricians receive little formal training in medical school or in residency regarding sleep medicine. An understanding of the physiology of sleep is critical to a pediatrician׳s ability to effectively and confidently counsel patients about sleep. The biological rhythm of sleep and waking is regulated through both circadian and homeostatic processes. Sleep also has an internal rhythmic organization, or sleep architecture, which includes sleep cycles of REM and NREM sleep. Arousal and sleep (REM and NREM) are active and complex neurophysiologic processes, involving both neural pathway activation and suppression. These physiologic processes change over the life course, especially in the first 5 years. Adequate sleep is often difficult to achieve, yet is considered very important to optimal daily function and behavior in children; thus, understanding optimal sleep duration and patterns is critical for pediatricians. There is little experimental evidence that guides sleep recommendations, rather normative data and expert recommendations. Effective counseling on child sleep must account for the child and parent factors (child temperament, parent-child interaction, and parental affect) and the environmental factors (cultural, geographic, and home environment, especially media exposure) that influence sleep. To promote health and to prevent and manage sleep problems, the American Academy of Pediatrics (AAP) recommends that parents start promoting good sleep hygiene, with a sleep-promoting environment and a bedtime routine in infancy, and throughout childhood. Thus, counseling families on sleep requires an understanding of sleep regulation, physiology, developmental patterns, optimal sleep duration recommendations, and the many factors that influence sleep and sleep hygiene.
71Sleep and the hypothalamus.PubMed
Antoine R Adamantidis, Luis de Lecea
Science. 2023 Oct 27;382(6669):405-412. doi: 10.1126/science.adh8285. Epub 2023 Oct 26.
Neural substrates of wakefulness, rapid eye movement sleep (REMS), and non-REMS (NREMS) in the mammalian hypothalamus overlap both anatomically and functionally with cellular networks that support physiological and behavioral homeostasis. Here, we review the roles of sleep neurons of the hypothalamus in the homeostatic control of thermoregulation or goal-oriented behaviors during wakefulness. We address how hypothalamic circuits involved in opposing behaviors such as core body temperature and sleep compute conflicting information and provide a coherent vigilance state. Finally, we highlight some of the key unresolved questions and challenges, and the promise of a more granular view of the cellular and molecular diversity underlying the integrative role of the hypothalamus in physiological and behavioral homeostasis.
72[Sleep and Body Temperature].PubMed
Asuka Ishihara, Insung Park, Kumpei Tokuyama
Brain Nerve. 2022 Feb;74(2):173-178. doi: 10.11477/mf.1416202003.
Mammals and birds seek a warm environment prior to sleep, which triggers vasodilatation and body cooling. Ambient temperatures outside the thermoneutral zone suppress sleep, particularly rapid eye movement (REM) sleep. We discuss the neurocircuit interactions associated with thermal and sleep regulation that occur primarily in the hypothalamic areas. An increase in ambient temperature stimulates the median preoptic/medial preoptic area of the hypothalamus, decreases body temperature, and increases non-REM sleep. Similarly, optical stimulation of the ventrolateral preoptic nucleus, which contains galanin (VLPO), results in body cooling and non-REM sleep. A decrease in VLPO disrupts sleep in elderly individuals and may also be associated with reduced decline in core body temperature during sleep. However, stimulation of neurons that synthesize melanin-concentrating hormone in the lateral hypothalamus decreases body temperature and induces REM sleep. We also discussed the acute effect of light on sleep induction and decreased body temperature, implicated with gamma-aminobutyric acid-ergic neurons in the preoptic area. Further investigation is needed to determine the mechanisms that induce physiological responses in diurnal and nocturnal species. These studies will contribute to a better understanding of the association between sleep and thermoregulation.
73Associations of bedroom PM, CO, temperature, humidity, and noise with sleep: An observational actigraphy study.PubMed
Mathias Basner, Michael G Smith, Christopher W Jones, et al.
Sleep Health. 2023 Jun;9(3):253-263. doi: 10.1016/j.sleh.2023.02.010. Epub 2023 Apr 18.
OBJECTIVE: Climate change and urbanization increasingly cause extreme conditions hazardous to health. The bedroom environment plays a key role for high-quality sleep. Studies objectively assessing multiple descriptors of the bedroom environment as well as sleep are scarce. METHODS: Particulate matter with a particle size <2.5 µm (PM), temperature, humidity, carbon dioxide (CO), barometric pressure, and noise levels were continuously measured for 14 consecutive days in the bedroom of 62 participants (62.9% female, mean ± SD age: 47.7 ± 13.2 years) who wore a wrist actigraph and completed daily morning surveys and sleep logs. RESULTS: In a hierarchical mixed effect model that included all environmental variables and adjusted for elapsed sleep time and multiple demographic and behavioral variables, sleep efficiency calculated for consecutive 1-hour periods decreased in a dose-dependent manner with increasing levels of PM, temperature, CO, and noise. Sleep efficiency in the highest exposure quintiles was 3.2% (PM, p < .05), 3.4% (temperature, p < .05), 4.0% (CO, p < .01), and 4.7% (noise, p < .0001) lower compared to the lowest exposure quintiles (all p-values adjusted for multiple testing). Barometric pressure and humidity were not associated with sleep efficiency. Bedroom humidity was associated with subjectively assessed sleepiness and poor sleep quality (both p < .05), but otherwise environmental variables were not statistically significantly associated with actigraphically assessed total sleep time and wake after sleep onset or with subjectively assessed sleep onset latency, sleep quality, and sleepiness. Assessments of bedroom comfort suggest subjective habituation irrespective of exposure levels. CONCLUSIONS: These findings add to a growing body of evidence highlighting the importance of the bedroom environment-beyond the mattress-for high-quality sleep.
74How do sleepwear and bedding fibre types affect sleep quality: A systematic review.PubMed
Xinzhu Li, Mark Halaki, Chin Moi Chow
J Sleep Res. 2024 Dec;33(6):e14217. doi: 10.1111/jsr.14217. Epub 2024 Apr 16.
Sleepwear and bedding materials can affect sleep quality by influencing the skin and body temperature and thermal comfort. This review systematically evaluates the impact of sleepwear or bedding of different fibre types on sleep quality. A systematic search was conducted in six data bases plus Google Scholar and manual searches. Original articles that compared human sleep quality between at least two fibre types of bedding or sleepwear were included, resulting in nine eligible articles included in the review. The fibre types included cotton, polyester, wool, and blended materials for sleepwear; cotton, duck down, goose down, polyester and wool for duvet; and linen and a combination of cotton and polyester for bedding. The interplay between fibre materials and sleep quality is complex. Blended sleepwear demonstrated potential benefits for specific populations. Wool sleepwear showed benefits for sleep onset in adults (cool conditions) and in older adults (warm conditions). Linen bedsheets improved sleep quality under warm conditions in young adults. Goose down-filled duvets increased slow-wave sleep under cool conditions in young adults. However, a systematic comparison of fibre types is challenging due to the diverse nature of the studies evaluating sleep quality. Further research employing standardised methodologies with standard fibre samples in different populations and in different temperature conditions is imperative to elucidate comprehensively the effects of fibre choices on sleep quality. Despite the limitations and heterogeneity of the included studies, this analysis offers valuable insights for individuals seeking to optimise their sleep experiences and for manufacturers developing sleep-related products.
75A cross-sectional survey on the effects of ambient temperature and humidity on health outcomes in individuals with chronic respiratory disease.PubMed
Samantha Mekhuri, Shirley Quach, Caroline Barakat, et al.
Can J Respir Ther. 2023 Dec 8;59:256-269. doi: 10.29390/001c.90653. eCollection 2023.
RATIONALE: Extremes of temperature and humidity are associated with adverse respiratory symptoms, reduced lung function, and increased exacerbations among individuals living with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To describe the reported effects of temperature and humidity extremes on the health outcomes, health status and physical activity (PA) in individuals living with COPD. METHODS: A cross-sectional self-reported survey collected the effects on health status (COPD Assessment Test [CAT]), PA, and health outcomes in 1) moderate/ideal (14 to 21°C, 30 to 50% relative humidity [RH]), 2) hot and humid (≥ 25°C, > 50% RH) and 3) cold and dry (≤ 5°C, < 30% RH) weather conditions. Participants were ≥ 40 years old with COPD or related chronic respiratory diseases (e.g., asthma, sleep apnea, interstitial lung disease, lung cancer) and residing in Canada for ≥ 1 year. Negative responders to weather extremes were defined as having a change of ≥ 2 points in the CAT. MAIN RESULTS: Thirty-six participants responded; the mean age (SD) was 65 (11) years, and 23 (64%) were females. Compared to ideal conditions, 23 (66%) and 24 (69%) were negatively affected by cold/dry and hot/humid weather, respectively. Health status was significantly lower, and PA amount and difficulty level were reduced in hot/humid and cold/dry conditions compared with ideal conditions. The number of exacerbations in hot/humid was significantly higher compared to ideal conditions. CONCLUSIONS: More participants were negatively affected by extremes of weather: health status worsened, PA decreased, and frequency of exacerbations was higher compared to ideal. Future prospective studies should directly and objectively investigate different combinations of extreme temperature and humidity levels on symptoms and PA to understand their long-term health outcomes.
76Effects of Air Conditioning-Induced Humidity Reduction on Glomerular Filtration Rate in Healthy Adults.PubMed
Xiang Li, Yaohui Ma, Gaosi Xu
Med Sci Monit. 2025 Jun 2;31:e948310. doi: 10.12659/MSM.948310.
BACKGROUND Air conditioning reduces indoor humidity, which can affect fluid balance and renal function. This study assessed the effect of short-term humidity reduction on estimated glomerular filtration rate (eGFR) in healthy adults. MATERIAL AND METHODS We conducted a cross-sectional and a self-controlled study in southern China enrolling. In the cross-sectional study, 12 671 healthy adults aged 18-75 years. There were 7120 participants in the air conditioning group (ACG) and 5551 in the electric fan group (FG), and. In the self-controlled study, 362 participants (mean age: 42.9±11.7 years) were exposed to both environments sequentially. Indoor humidity and temperature were recorded overnight using digital sensors. After 8 hours of sleep, fasting blood and urine samples were collected. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. RESULTS In the cross-sectional study, indoor humidity was lower in the air conditioning group (ACG: 48% [44-52%]) compared to the fan group (FG: 80% [77-83%], P<0.001). Mean eGFRMDRD was significantly lower in the ACG (105.3±16.5 mL/min/1.73 m²) than in the FG (109.1±17.0 mL/min/1.73 m², P<0.001). In the self-controlled study, eGFRMDRD was also reduced after air conditioning exposure (104.6±15.8 vs 108.4±15.7 mL/min/1.73 m², P<0.001). CONCLUSIONS Low indoor humidity due to air conditioning is associated with a modest but significant decline in eGFR in healthy adults.
77Circadian Rhythms Disrupted by Light at Night and Mistimed Food Intake Alter Hormonal Rhythms and Metabolism.PubMed
O Hecmarie Meléndez-Fernández, Jennifer A Liu, Randy J Nelson
Int J Mol Sci. 2023 Feb 8;24(4):3392. doi: 10.3390/ijms24043392.
Availability of artificial light and light-emitting devices have altered human temporal life, allowing 24-hour healthcare, commerce and production, and expanding social life around the clock. However, physiology and behavior that evolved in the context of 24 h solar days are frequently perturbed by exposure to artificial light at night. This is particularly salient in the context of circadian rhythms, the result of endogenous biological clocks with a rhythm of ~24 h. Circadian rhythms govern the temporal features of physiology and behavior, and are set to precisely 24 h primarily by exposure to light during the solar day, though other factors, such as the timing of meals, can also affect circadian rhythms. Circadian rhythms are significantly affected by night shift work because of exposure to nocturnal light, electronic devices, and shifts in the timing of meals. Night shift workers are at increased risk for metabolic disorder, as well as several types of cancer. Others who are exposed to artificial light at night or late mealtimes also show disrupted circadian rhythms and increased metabolic and cardiac disorders. It is imperative to understand how disrupted circadian rhythms alter metabolic function to develop strategies to mitigate their negative effects. In this review, we provide an introduction to circadian rhythms, physiological regulation of homeostasis by the suprachiasmatic nucleus (SCN), and SCN-mediated hormones that display circadian rhythms, including melatonin and glucocorticoids. Next, we discuss circadian-gated physiological processes including sleep and food intake, followed by types of disrupted circadian rhythms and how modern lighting disrupts molecular clock rhythms. Lastly, we identify how disruptions to hormones and metabolism can increase susceptibility to metabolic syndrome and risk for cardiovascular diseases, and discuss various strategies to mitigate the harmful consequences associated with disrupted circadian rhythms on human health.
78The influence of blue light on sleep, performance and wellbeing in young adults: A systematic review.PubMed
Marcia Ines Silvani, Robert Werder, Claudio Perret
Front Physiol. 2022 Aug 16;13:943108. doi: 10.3389/fphys.2022.943108. eCollection 2022.
Blue light from electronic devices has a bad reputation. It has a wavelength which may influence our circadian rhythm and cause bad sleep. But there are other aspects of blue light exposure which are often overlooked, for example, it may influence performance and wellbeing. However, few resources summarize its effects systematically. Therefore, the goal of this systematic review was to distil the present evidence on blue light exposure and its influence on sleep, performance and wellbeing and discuss its significance for athletes. The databases that were searched were Cochrane, Embase, Pubmed, Scopus, and Virtual Health Library. The studies included investigated the influence of blue light exposure on either sleep, performance, wellbeing or a combination of those parameters on healthy humans. Quality assessment was done based on the quantitative assessment tool "QualSyst." Summarizing the influence of blue light exposure, the following results were found (expressed as proportion to the number of studies investigating the particular parameter): Fifty percent of studies found tiredness to be decreased. One fifth of studies found sleep quality to be decreased and one third found sleep duration to be decreased. Half of the studies found sleep efficacy to be decreased and slightly less than half found sleep latency to be increased. More than one half of the studies found cognitive performance to be increased. Slightly more than two thirds found alertness to be increased and reaction time to be decreased. Slightly less than half of the studies found wellbeing to be increased. Blue light exposure can positively affect cognitive performance, alertness, and reaction time. This might benefit sports reliant on team-work and decision-making and may help prevent injury. Blue light might also have negative effects such as the decrease in sleep quality and sleep duration, which might worsen an athlete's physical and cognitive performance and recovery. Further research should explore if blue light can improve sleep, performance and wellbeing to significantly benefit athletic performance.
79Artificial Light at Night and Type 2 Diabetes Mellitus.PubMed
Jong-Ha Baek, Yong Zhu, Chandra L Jackson, et al.
Diabetes Metab J. 2024 Sep;48(5):847-863. doi: 10.4093/dmj.2024.0237. Epub 2024 Sep 1.
The widespread and pervasive use of artificial light at night (ALAN) in our modern 24-hour society has emerged as a substantial disruptor of natural circadian rhythms, potentially leading to a rise in unhealthy lifestyle-related behaviors (e.g., poor sleep; shift work). This phenomenon has been associated with an increased risk of type 2 diabetes mellitus (T2DM), which is a pressing global public health concern. However, to date, reviews summarizing associations between ALAN and T2DM have primarily focused on the limited characteristics of exposure (e.g., intensity) to ALAN. This literature review extends beyond prior reviews by consolidating recent studies from 2000 to 2024 regarding associations between both indoor and outdoor ALAN exposure and the incidence or prevalence of T2DM. We also described potential biological mechanisms through which ALAN modulates glucose metabolism. Furthermore, we outlined knowledge gaps and investigated how various ALAN characteristics beyond only light intensity (including light type, timing, duration, wavelength, and individual sensitivity) influence T2DM risk. Recognizing the detrimental impact of ALAN on sleep health and the behavioral correlates of physical activity and dietary patterns, we additionally summarized studies investigating the potential mediating role of each component in the relationship between ALAN and glucose metabolism. Lastly, we proposed implications of chronotherapies and chrononutrition for diabetes management in the context of ALAN exposure.
80Individual interventions to reduce nighttime light exposure in a representative sample of adults aged 18-64 years in Poland.PubMed
Radosław Sierpiński, Mateusz Jankowski, Filip Raciborski
Int J Occup Med Environ Health. 2025 Nov 12;38(5):559-571. doi: 10.13075/ijomeh.1896.02668. Epub 2025 Oct 22.
OBJECTIVES: Exposure to nighttime light pollution has a multidimensional environmental impact and is associated with harmful health effects. This study aimed to characterize individual interventions to reduce nighttime light exposure among adults in Poland and to identify factors associated with the implementation of individual interventions to reduce nighttime light exposure. MATERIAL AND METHODS: This is a secondary analysis of data obtained from the nationwide cross-sectional survey conducted in December 2024 in a representative sample of 5006 adults (18-64 years) in Poland. Respondents were asked about the implementation of 5 different interventions to reduce nighttime light exposure. RESULTS: Among all respondents (N = 5006), the most common intervention to reduce nighttime light exposure was the use of blackout curtains in the bedroom (41.4% of respondents), followed by limiting screen time in the evening (17.6% of respondents). Among the respondents, 14.7% declared turning off indicator lights on electronic devices or using light bulbs with a warmer color. The least common method was using an eye mask (3.9% of respondents). In total, 65% of respondents had implemented ≥1 individual intervention to reduce exposure to nighttime light pollution. Age 18-44 years, having a full-time or part-time job, good financial situation, having sleep problems, and looking for health-related information were significantly associated (p < 0.05) with the implementation of ≥1 intervention to reduce exposure to nighttime light pollution. The most important factor associated with the intervention to reduce exposure to nighttime light pollution was active seeking health information (OR = 2.17, 95% CI: 1.9-2.48, p < 0.001). There was no significant impact of gender, educational level or place of residence (p > 0.05). CONCLUSIONS: This study revealed a gap in the implementation of individual interventions to reduce exposure to nighttime light pollution among adults in Poland. There is an urgent need to promote the prevention of environmental hazards like light pollution among adults in Poland. Int J Occup Med Environ Health. 2025;38(5):559-71.
81Age and sex differences in bedroom habits and bedroom preferences.PubMed
Bjørn Bjorvatn, Jelena Mrdalj, Ingvild W Saxvig, et al.
Sleep Med. 2017 Apr;32:157-161. doi: 10.1016/j.sleep.2017.01.003. Epub 2017 Jan 20.
OBJECTIVE: The objective of this study was to estimate the prevalence of different bedroom habits/preferences, and to assess whether these habits/preferences differ with age and sex. METHODS: A population-based Norwegian cross-sectional telephone survey with 1001 of 1599 randomly selected adults (63% response rate) was performed. The questions about habits and preferences had different response alternatives (yes/no; up to eight response alternatives). Mean age was 47.5 years, and split into four groups (18-29, 30-44, 45-59, 60+ years). Age and sex differences were explored with chi-square statistics. RESULTS: Electronic media use in bed after bedtime was more common in younger compared to older age groups, with no sex difference. Daily use was reported by 61.8% of participants aged 18-29 years, compared to 3.7% among participants of 60+ years. Reading in bed after bedtime was more common with increasing age, and more common among females compared to males. Females and older participants more often rated their bed as very good. The older the participants, the colder the reported bedroom temperature. During winter, 48.5% of participants aged 60+ years reported a bedroom temperature of ≤12 °C. Many participants (39.2%) reported having their bedroom window always open at night, with no sex difference, but an increase with increasing age. Blackout curtains were used by 63.3%, with a drop in use with increasing age. Most participants preferred lying on the side when trying to sleep. Fewer older compared to younger participants preferred lying on the stomach. CONCLUSIONS: The findings may stimulate further studies exploring whether these habits/preferences may influence sleep and sleep disorders.
82Efficacy of Sleep Tool Education During Hospitalization: A Randomized Controlled Trial.PubMed
Peter M Farrehi, Kristen R Clore, J Ryan Scott, et al.
Am J Med. 2016 Dec;129(12):1329.e9-1329.e17. doi: 10.1016/j.amjmed.2016.08.001. Epub 2016 Aug 23.
BACKGROUND: Patients are commonly provided tools in the hospital to overcome poor sleep. Whether education on use of sleep tools can impact health outcomes from a patient perspective is not known. METHODS: We recruited 120 adults admitted to a nonintensive care unit cardiac-monitored floor. All patients received a set of sleep-enhancing tools (eye mask, ear plugs, and a white noise machine) and were randomized to receive direct education on use of and benefit of these sleep-enhancing tools (intervention), or an equal amount of time was spent discussing general benefits of sleep (control). Measurement of several symptom domains was assessed daily by health outcome survey responses, and change from baseline was assessed for differences between groups. Inpatient opioid use and length of stay were also measured. RESULTS: Participants randomized to receive the education intervention had a significantly greater decrease in fatigue scores over the 3 days, compared with controls (5.30 ± 6.93 vs 1.81 ± 6.96, t = 2.32, P = .028). There was a trend toward improvements in multiple other sleep-related domains, including sleep disturbance, sleep-related impairment, physical functioning, pain severity, or pain interference (all P >.140). There was no difference in length of stay between intervention and control groups (7.40 ± 7.29 vs 7.71 ± 6.06 days, P = .996). The change in number of opioid equivalents taken did not differ use between the groups (P = .688). CONCLUSION: In a randomized trial of education in the use of sleep-enhancing tools while hospitalized, patient fatigue was significantly improved, whereas several other patient-reported outcomes showed a trend toward improvements. Implementation of this very low-cost approach to improving sleep and well-being could substantially improve the patient care experience.
83The effects of white noise on sleep and duration in individuals living in a high noise environment in New York City.PubMed
Matthew R Ebben, Peter Yan, Ana C Krieger
Sleep Med. 2021 Jul;83:256-259. doi: 10.1016/j.sleep.2021.03.031. Epub 2021 Apr 6.
INTRODUCTION: Undisturbed sleep has been shown to be important for both health and quality of life (Medic et al. [7]). The World Health Organization estimates that nearly 25% of the population suffers from disturbed sleep due to environmental noise (Health TWECfEa, [2]). Sleep disturbance associated with elevated noise levels is particularly prevalent in metropolitan areas. Our study tested the hypothesis that white noise would improve sleep in New Yorkers complaining of sleep difficulty due to elevated sound levels. METHODS: Ten adult participants were included in this study. All participants were recruited from a New York City based sleep clinic. Inclusion criteria was based on the presence of sleep disturbance and the reporting of high levels of environmental noise in participants' sleep location. The study was conducted using a within-subject, ABA design, with baseline, treatment phase, followed by another baseline (washout) period. Each phase lasted one-week, during which noise level and sleep were assessed. The treatment consisted of the application of a white noise device (Dohm Classic by Marpac, LLC) in the participants' bedroom. Sleep parameters were measured subjectively using the Consensus Sleep Diary (Carney et al. [15]), and objectively using a Motionlogger Actigraph. RESULTS: Paired sample t-tests were conducted to evaluate the hypothesis that white noise improves sleep in a high noise environment. Significance was found on the variables WASO, as measured by actigraphy, t(9) = 3.438, p = 0.007 and sleep latency as measured by sleep diary, t(9) = 2.947, p = 0.016. There was a trend toward significance on the number of awakenings during the night, as measured by sleep diary, t(9) = 2.622, p = 0.028 (Holm's sequential correction of p-value required a value of <0.01 to find significance on this comparison) and sleep efficiency (actigraph), t(9) = -2.121, p = 0.063. CONCLUSION: Our data show that white noise significantly improved sleep based on subjective and objective measurements in subjects complaining of difficulty sleeping due to high levels of environmental noise. This suggests that the application of white noise may be an effective tool in helping to improve sleep in those settings.
84Impact and efficacy of sound machine on sleep in hospitalized adults: A systematic review.PubMed
Kanika Khandelwal, Alecia Anyim, Sara Shu, et al.
Sleep Med X. 2025 Sep 29;10:100154. doi: 10.1016/j.sleepx.2025.100154. eCollection 2025 Dec 15.
BACKGROUND: Sleep in hospitalized adults is impaired due to several reasons. Non-pharmacological approaches should be attempted first before considering medications to treat insomnia. Environmental noise levels in the hospital are also a major culprit that might result in disturbed sleep. While limiting any disturbance or sound during sleeping hours is crucial, it might not be completely feasible in the acute care setting. Sound machines that deliver a masking noise such as white noise are reported to mask these environmental noises and promote sleep. We aim to analyze the efficacy and safety of sound machines on sleep efficiency in hospitalized adults. METHODS: A systematic review of all published literature was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched MEDLINE, Embase, Cochrane Cochrane Central Register of Controlled Trials, EBSCO CINAHL, Google scholar, APA PsycINFO, Web of Science, and Scopus from inception to August 13, 2024. All studies that reported sound machine-based interventions on sleep efficiency in hospitalized adults were included. Sleep efficiency and other sleep related outcomes as total sleep time, latency, awakenings, and total sleep score were noted. Cochrane Risk of Bias 2 for RCTs was used to evaluate study quality. This study was registered with PROSPERO (CRD42024595293). RESULTS: A total of 1920 studies were screened, of which 74 were selected for full text review. Seven RCT studies ( = 496 participants) met the inclusion criteria and were included. Two studies were from USA, and India each, while one study was reported each from Iran, China, and South Korea. Six of the seven studies used white noise, while one study reported using Uncorrelated Signal and Ambient noise in Space Integration (USASI) masking noise. Two studies reported using Pittsburgh Sleep Quality Index (PSQI), and Richards Campbell Sleep Questionnaire (RCSQ) each to measure sleep outcomes. White noise was well tolerated with no major adverse effects reported, and only 8 participants discontinued the study due to discomfort or found it less acceptable. Collectively, these studies provide evidence of improved sleep efficiency with white noise use in hospitalized adults. Given the heterogeneity in the duration of white noise use, inclusion criteria, and the outcome measurement scales in this small sample of RCT studies, meta-analysis was not feasible. CONCLUSIONS: White-noise and other similar masking noises seem to improve sleep efficiency in hospitalized adults, with good tolerability. Only limited studies report the efficacy and demonstrate wide heterogeneity in the duration of masking noise use, varied inclusion criteria, and outcome measurement scales. Larger studies analyzing the hospitalized patient population type, across different units, to identify the best patient population who would benefit from these masking sounds are needed.
85Noise as a sleep aid: A systematic review.PubMed
Samantha M Riedy, Michael G Smith, Sarah Rocha, et al.
Sleep Med Rev. 2021 Feb;55:101385. doi: 10.1016/j.smrv.2020.101385. Epub 2020 Sep 9.
White noise is purported to mask disruptive noises in the bedroom environment and be a non-pharmacological approach for promoting sleep and improving sleep quality. We conducted a systematic review of all studies examining the relationships between continuous white noise or similar broadband noise and sleep (PROSPERO 2020: CRD42020148736). Animal studies and studies using intermittent white noise to disrupt sleep or enhance slow wave activity were excluded. Two reviewers independently screened titles and abstracts of articles from three databases and assessed risk of bias for the 38 included articles. The primary outcomes described sleep onset latency, sleep fragmentation, sleep quality, and sleep and wake duration. There was heterogeneity in noise characteristics, sleep measurement methodology, adherence to the intervention, control group conditions or interventions, and presence of simultaneous experimental interventions. There was perhaps resultantly variability in research findings, with the extremes being that continuous noise improves or disrupts sleep. Following the GRADE criteria, the quality of evidence for continuous noise improving sleep was very low, which contradicts its widespread use. Additional research with objective sleep measures and detailed descriptions of noise exposure is needed before promoting continuous noise as a sleep aid, especially since it may also negatively affect sleep and hearing.
86Systematic review: auditory stimulation and sleep.PubMed
Elizabeth Capezuti, Kevin Pain, Evelyn Alamag, et al.
J Clin Sleep Med. 2022 Jun 1;18(6):1697-1709. doi: 10.5664/jcsm.9860.
STUDY OBJECTIVES: Auditory stimulation devices (white and pink noise) are used to mask sounds and facilitate relaxation and sleep; however, the effectiveness of this intervention is not well established. This systematic review examined the scientific literature for the effect of specific types of auditory stimulation on sleep outcomes in adults. METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guided this review. Searches were conducted in 9 databases for intervention studies that could easily be employed in clinical practice. We excluded other types of auditory stimulation (music alone, binaural tones, and synchronization). Two reviewers screened abstracts and full-text articles for eligibility, with conflicts resolved by a third reviewer, and extracted data. Risk of bias was assessed with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS: Thirty-four studies reported results of 1,103 persons participating in 3 categories of interventions: white noise (18), pink noise (11), and 6 multiaudio (some combination of white, pink, music, or silence). Nineteen studies had positive findings in terms of improving sleep outcomes: 6 white noise (33%), 9 pink noise (81.9%), and 4 multiaudio (66.7%). Multiaudio had the lowest (better) risk of bias (mean/standard deviation: 1.67/0.82) compared to white (2.38/0.69) and pink noise (2.36/0.81). CONCLUSIONS: Although there was no strong evidence to support use of auditory stimulation, none of the studies reported any adverse effects with short-term application of auditory stimulation during sleep. Future research needs to include confounding factors that can affect outcomes, including one's noise sensitivity, personality, and other conditions or medications that may affect sleep. CITATION: Capezuti E, Pain K, Alamag E, Chen XQ, Philibert V, Krieger AC. Systematic review: auditory stimulation and sleep. . 2022;18(6):1697-1709.
87Continuous white noise exposure during sleep and childhood development: A scoping review.PubMed
Russell W De Jong, Gavin S Davis, Cynthia J Chelf, et al.
Sleep Med. 2024 Jul;119:88-94. doi: 10.1016/j.sleep.2024.04.006. Epub 2024 Apr 16.
BACKGROUND: White noise machines are widely used as a sleep aid for young children and may lead to poor hearing, speech, and learning outcomes if used incorrectly. OBJECTIVE: Characterize the potential impact of chronic white noise exposure on early childhood development. METHODS: Embase, Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science were searched from inception through June 2022 for publications addressing the effects of chronic noise exposure during sleep on early development in animals and children. PRISMA-ScR guidelines were followed. Among 644 retrieved publications, 20 met inclusion criteria after review by multiple authors. Seven studies evaluated animal models and 13 studies examined pediatric subjects, including 83 animal and 9428 human subjects. RESULTS: White noise machines can exceed 91 dB on maximum volume, which exceeds the National Institute for Occupational Safety and Health noise exposure guidelines for a 2-h work shift in adults. Evidence suggests deleterious effects of continuous moderate-intensity white noise exposure on early development in animal models. Human subject data generally corroborates these models; however, studies also suggest low-intensity noise exposure may be beneficial during sleep. CONCLUSIONS: Existing data support the limitation of maximal sound intensity and duration on commercially available white noise devices. Further research into the optimal intensity and duration of white noise exposure in children is needed.
88Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis.PubMed
James M Trauer, Mary Y Qian, Joseph S Doyle, et al.
Ann Intern Med. 2015 Aug 4;163(3):191-204. doi: 10.7326/M14-2841.
BACKGROUND: Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia. PURPOSE: To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with chronic insomnia. DATA SOURCES: Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening. STUDY SELECTION: Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia. Studies of insomnia comorbid with medical, sleep, or psychiatric disorders were excluded. DATA EXTRACTION: Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). DATA SYNTHESIS: Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64% female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95% CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE% improved by 9.91% (CI, 8.09% to 11.73%). Changes seemed to be sustained at later time points. No adverse outcomes were reported. LIMITATION: Narrow inclusion criteria limited applicability to patients with comorbid insomnia and other sleep problems, and accuracy of estimates at later time points was less clear. CONCLUSION: CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes. PRIMARY FUNDING SOURCE: None. (PROSPERO registration number: CRD42012002863).
89Insomnia in the Older Adult.PubMed
Glenna S Brewster, Barbara Riegel, Philip R Gehrman
Sleep Med Clin. 2022 Jun;17(2):233-239. doi: 10.1016/j.jsmc.2022.03.004.
Although insomnia is not a normal part of the aging process, its prevalence increases with age. Factors such as medications and medical and psychiatric disorders can increase the risk for insomnia. In order to diagnose insomnia, it is important for older adults to complete comprehensive sleep and health histories. Cognitive behavioral therapy for insomnia, which includes stimulus control, sleep restriction, sleep hygiene, and cognitive therapy, is the recommended first-line treatment of insomnia and is more effective that medications for the long-term management of insomnia. Medications such as benzodiazepines and antidepressants should be avoided for the treatment of insomnia in older adults.
90Non-pharmacological Approaches for Management of Insomnia.PubMed
Ngan Yin Chan, Joey Wing Yan Chan, Shirley Xin Li, et al.
Neurotherapeutics. 2021 Jan;18(1):32-43. doi: 10.1007/s13311-021-01029-2. Epub 2021 Apr 5.
Insomnia is a prevalent sleep problem associated with a constellation of negative health-related outcomes and significant socioeconomic burden. It commonly co-occurs with psychiatric and medical conditions, which may further exacerbate these comorbid conditions and hinder treatment response. There is much empirical evidence to support the clinical efficacy of non-pharmacological treatment for insomnia, especially cognitive behavioral therapy for insomnia (CBT-I), in managing insomnia in a wide range of populations. This article reviews the research on the efficacy of CBT-I for primary insomnia and insomnia comorbid with other psychiatric and medical conditions, the empirical evidence regarding different CBT-I treatment modalities, the implementation of CBT-I across different age groups, and some initial evidence on the sequential combination of insomnia treatments. A brief overview of other non-pharmacological treatment with regard to complementary alternative medicine is also provided.
91Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Insomnia in Adults: A Systematic Review and Component Network Meta-Analysis.PubMed
Yuki Furukawa, Masatsugu Sakata, Ryuichiro Yamamoto, et al.
JAMA Psychiatry. 2024 Apr 1;81(4):357-365. doi: 10.1001/jamapsychiatry.2023.5060.
IMPORTANCE: Chronic insomnia disorder is highly prevalent, disabling, and costly. Cognitive behavioral therapy for insomnia (CBT-I), comprising various educational, cognitive, and behavioral strategies delivered in various formats, is the recommended first-line treatment, but the effect of each component and delivery method remains unclear. OBJECTIVE: To examine the association of each component and delivery format of CBT-I with outcomes. DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, PsycInfo, and International Clinical Trials Registry Platform from database inception to July 21, 2023. STUDY SELECTION: Published randomized clinical trials comparing any form of CBT-I against another or a control condition for chronic insomnia disorder in adults aged 18 years and older. Insomnia both with and without comorbidities was included. Concomitant treatments were allowed if equally distributed among arms. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers identified components, extracted data, and assessed trial quality. Random-effects component network meta-analyses were performed. MAIN OUTCOMES AND MEASURES: The primary outcome was treatment efficacy (remission defined as reaching a satisfactory state) posttreatment. Secondary outcomes included all-cause dropout, self-reported sleep continuity, and long-term remission. RESULTS: A total of 241 trials were identified including 31 452 participants (mean [SD] age, 45.4 [16.6] years; 21 048 of 31 452 [67%] women). Results suggested that critical components of CBT-I are cognitive restructuring (remission incremental odds ratio [iOR], 1.68; 95% CI, 1.28-2.20) third-wave components (iOR, 1.49; 95% CI, 1.10-2.03), sleep restriction (iOR, 1.49; 95% CI, 1.04-2.13), and stimulus control (iOR, 1.43; 95% CI, 1.00-2.05). Sleep hygiene education was not essential (iOR, 1.01; 95% CI, 0.77-1.32), and relaxation procedures were found to be potentially counterproductive(iOR, 0.81; 95% CI, 0.64-1.02). In-person therapist-led programs were most beneficial (iOR, 1.83; 95% CI, 1.19-2.81). Cognitive restructuring, third-wave components, and in-person delivery were mainly associated with improved subjective sleep quality. Sleep restriction was associated with improved subjective sleep quality, sleep efficiency, and wake after sleep onset, and stimulus control with improved subjective sleep quality, sleep efficiency, and sleep latency. The most efficacious combination-consisting of cognitive restructuring, third wave, sleep restriction, and stimulus control in the in-person format-compared with in-person psychoeducation, was associated with an increase in the remission rate by a risk difference of 0.33 (95% CI, 0.23-0.43) and a number needed to treat of 3.0 (95% CI, 2.3-4.3), given the median observed control event rate of 0.14. CONCLUSIONS AND RELEVANCE: The findings suggest that beneficial CBT-I packages may include cognitive restructuring, third-wave components, sleep restriction, stimulus control, and in-person delivery but not relaxation. However, potential undetected interactions could undermine the conclusions. Further large-scale, well-designed trials are warranted to confirm the contribution of different treatment components in CBT-I.
92Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.PubMed
Jack D Edinger, J Todd Arnedt, Suzanne M Bertisch, et al.
J Clin Sleep Med. 2021 Feb 1;17(2):263-298. doi: 10.5664/jcsm.8988.
INTRODUCTION: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. METHODS: The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. RESULTS: The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations.
93Common Sleep Disorders Affecting Older Adults.PubMed
Ecler Ercole Jaqua, Mary Hanna, Wessam Labib, et al.
Perm J. 2023 Mar 15;27(1):122-132. doi: 10.7812/TPP/22.114. Epub 2022 Dec 12.
Sleep disorders in older adults increase with aging, likely due to increased sleep latency, decreased sleep efficiency, and total sleep time. Common sleep issues include chronic insomnia, circadian rhythm sleep-wake disorders, sleep-related movement disorders, and sleep-disordered breathing. Diagnostic tools, such as a comprehensive sleep history and questionnaires, or a sleep log for more specific complaints, are commonly used. Polysomnography is not recommended as a routine test; however, it can be used for abnormal behaviors during sleep or if treatment fails. Sleep disorder management is based on the etiology and may include nonpharmacological and pharmacological alternative treatments. For example, nonpharmacological management for chronic insomnia and some sleep disorders may consist of cognitive behavioral therapy, sleep hygiene education, relaxation therapy, sleep restriction, light therapy, and stimulus control therapy. Because the quality of evidence for pharmacological treatment is poor, the medication choice should be based on shared decision-making between the practitioner and the patient, with limited prescription.
94Cognitive Behavioral Therapy for Insomnia (CBT-i) in School-Aged Children and Adolescents.PubMed
Julia Dewald-Kaufmann, Ed de Bruin, Gradisar Michael
Sleep Med Clin. 2019 Jun;14(2):155-165. doi: 10.1016/j.jsmc.2019.02.002. Epub 2019 Apr 1.
Insomnia is one of the most prevalent sleep disorders in school-aged children and adolescents. Although cognitive behavioral therapy for insomnia (CBT-i) is the first-line treatment for adults, and existing studies show promising effects also for children and adolescents, the number of randomized controlled trials in younger age groups is rather small. CBT-i techniques for school-aged children and adolescents include bedtime shifts (including sleep restriction), stimulus control, thought challenging, psychoeducation, and relaxation techniques. The integration of parents, especially in school-aged children with insomnia, is highly recommended. More research is needed to investigate specific characteristics and models of child and adolescent insomnia.
95Short- and Long-Term Outcomes of e-Health and Internet-Based Psychological Interventions for Chronic Tinnitus: A Systematic Review and Meta-Analysis.PubMed
Heribert Sattel, Petra Brueggemann, Kurt Steinmetzger, et al.
Telemed J E Health. 2025 Feb;31(2):151-166. doi: 10.1089/tmj.2024.0050. Epub 2024 Oct 25.
: e-Health or web-based systems in the field of tinnitus have gained increasing interest. Cognitive behavioral therapy (CBT) delivered via the internet is currently witnessing a surge in both attention and offerings. This systematic review analyzed the efficacy and sustainability of internet-based therapies aimed at reducing tinnitus distress and comorbidities such as anxiety, depression, and sleep disorders. The review exclusively considered randomized controlled trials (RCTs) in which trained personnel were actively involved during intervention. : Utilizing search terms such as tinnitus, internet-based therapy, and e-Health therapy, we identified 155 studies, from which 37 RCTs were carefully examined for data availability. Primary outcome measures included treatment effects for tinnitus distress (Tinnitus Questionnaire and other questionnaires) and handicap (Tinnitus Handicap Inventory), while secondary outcomes encompassed depression, anxiety, and sleep problems. Meta-analyses were conducted employing random-effect models. A study effect model was applied, yielding a singular effect size for each sample. The effect sizes were examined for influences of various moderators. : We found a statistically significant large effect size for improvement in tinnitus distress ( = 0.83; [confidence interval 0.61-1.06] with total = 450 for the experimental group and total = 504 or the controls), while the reduction of tinnitus handicap was smaller (moderate effect size = 0.59; [0.44-0.73]). Less strong but still significant effects resulted for depression, anxiety, and insomnia. Most of the long-term outcomes remained stable. As moderators, the risk of bias (RoB) and the severity of tinnitus manifestations were identified. : Internet-based therapy provides a valuable avenue for initial therapeutic contact, as supporting component in tinnitus treatment if accompanied by therapists. The heterogeneous quality with high drop-out rates or partly high RoB and the wide range of interventions (counseling, eCBT, mindfulness) might be considered as a limiting factor for a first-line management in tinnitus. So far, the use of e-Health is dependent on availability or user preferences.
96Effectiveness of app-based cognitive behavioral therapy for insomnia on preventing major depressive disorder in youth with insomnia and subclinical depression: A randomized clinical trial.PubMed
Si-Jing Chen, Jian-Yu Que, Ngan Yin Chan, et al.
PLoS Med. 2025 Jan 21;22(1):e1004510. doi: 10.1371/journal.pmed.1004510. eCollection 2025 Jan.
BACKGROUND: Increasing evidence suggests that insomnia plays an important role in the development of depression, supporting insomnia intervention as a promising approach to prevent depression in youth. This randomized controlled trial evaluated the effectiveness of app-based cognitive behavioral therapy for insomnia (CBT-I) in preventing future onset of major depressive disorder (MDD) in youth. METHODS AND FINDINGS: This was a randomized, assessor-blind, parallel group-controlled trial in Chinese youth (aged 15-25 years) with insomnia disorder and subclinical depressive symptoms. Participants were randomly assigned (1:1) to 6-week app-based CBT-I or 6-week app-based health education (HE) delivered through smartphones. Online assessments and telephone clinical interviews were conducted at baseline, post-intervention, 6- and 12-month follow-ups. The primary outcome was time to onset of MDD. The secondary outcomes included depressive symptoms and insomnia at both symptom and disorder levels. Between September 9, 2019, and November 25, 2022, 708 participants (407 females [57%]; mean age, 22.1 years [SD = 1.9]) were randomly allocated to app-based CBT-I group (n = 354) or app-based HE group (n = 354). Thirty-seven participants (10%) in the intervention group and 62 participants (18%) in the control group developed new-onset MDD throughout the 12-month follow-up, with a hazard ratio of 0.58 (95% confidence interval 0.38-0.87; p = 0.008). The number needed to treat to prevent MDD at 1 year was 10.9 (6.8-26.6). The app-based CBT-I group has higher remission rates of insomnia disorder than the controls at post-intervention (52% versus 28%; relative risk 1.83 [1.49-2.24]; p < 0.001) and throughout 12-month follow-up. In addition, the CBT-I group reported a greater decrease in depressive (adjusted difference -1.0 [-1.6 to -0.5]; Cohen's d = 0.53; p < 0.001) and insomnia symptoms (-2.0 [-2.7 to -1.3], d = 0.78; p < 0.001) than the controls at post-intervention and throughout 6-month follow-up. Insomnia was a mediator of intervention effects on depression. No adverse events related to the interventions were reported. CONCLUSIONS: App-based CBT-I is effective in preventing future onset of major depression and improving insomnia outcomes among youth with insomnia and subclinical depression. These findings highlight the importance of targeting insomnia to prevent the onset of MDD and emphasize the need for wider dissemination of digital CBT-I to promote sleep and mental health in the youth population. TRIAL REGISTRATION: ClinicalTrials.Gov (NCT04069247).
97Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis.PubMed
Zainab Alimoradi, Elahe Jafari, Anders Broström, et al.
Sleep Med Rev. 2022 Aug;64:101646. doi: 10.1016/j.smrv.2022.101646. Epub 2022 May 10.
The effects of cognitive behavioral therapy for insomnia (CBT-I) have consistently been shown to improve insomnia symptoms and other health-related outcomes, but the effects on QoL have been inconsistent. Many factors including the type CBT-I delivery and type of instrument used to assess QoL make the topic complex. The present systematic review and meta-analysis synthesized the evidence of CBT-I efficacy on QoL outcomes across different populations, delivery modes, and methodological aspects. Following the guidelines on preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a literature search was conducted through PubMed, Web of Science, Scopus, and PsycINFO using keywords from relevant MeSH terms based on PICOS (Participants, Intervention, Comparison, Outcome and Study) criteria. Clinical trials investigating the effect of CBT-I as an intervention on QoL with any kind of control group were eligible if they reported mean scores and variation of QoL. Meta-analysis using a random-effect model was conducted to calculate the standardized mean differences (SMDs) in a set including all identified studies, as well as in three sub-sets: face-to-face CBT-I using randomized controlled trials (RCTs), online CBT-I using RCTs, and one-group pre- and post-treatment design. A total of 24 studies comprising 1977 participants (808 in an intervention group) from 12 countries were eligible for meta-analysis. The overall pooled estimate of SMD of QoL when all 24 studies were included was 0.47 (95% CI: 0.22; 0.72; I = 84.5%; tau = 0.31; p < 0.001). The overall pooled estimate of SMD of QoL was 0.46 (95% CI: 0.01-0.90; I = 87.5%; tau = 0.48, p < 0.001) for intervention groups with face-to-face CBT-I compared to controls; 0.47 (95% CI: 0.02-0.92; I = 88.3%; tau = 0.36; p = 0.04) for intervention groups with digital CBT-I compared to controls, and 0.46 (95% CI: 0.12-0.80; I = 52.9%; tau = 0.07; p = 0.08) for one-group pre- and post-comparison using CBT-I intervention compared to baseline. Moreover, effects of CBT-I on QoL were different across populations (pooled SMD = 0.59 for patients with insomnia; 0.29 for patients with insomnia comorbid with another major disorder; and 0.48 for other conditions) and types of QoL instruments (pooled SMD = 0.36 for disease-specific QoL instrument not on insomnia, 0.43 for generic QoL instrument, and 0.67 for a single-QoL-item instrument). The probability of publication bias was ruled out in overall and design specific sub-group analysis based on funnel plot and Egger's test. In conclusion, this meta-analysis confirmed a moderate, overall effect of CBT-I in improving QoL. However, due to small power and heterogeneity, future studies are needed to better explore the impact of moderating factors such as mode of delivery and type of QoL measure for assessment used.
98Digital Cognitive Behavioral Therapy for Insomnia Using a Smartphone Application in China: A Pilot Randomized Clinical Trial.PubMed
Cheng Zhang, Yuxuan Liu, Xiaoming Guo, et al.
JAMA Netw Open. 2023 Mar 1;6(3):e234866. doi: 10.1001/jamanetworkopen.2023.4866.
IMPORTANCE: Digital cognitive behavioral therapy for insomnia (DCBT-I) requires adaptation to different sociocultural contexts. Moreover, studies comparing DCBT-I and sleep education in the same operating interface are lacking. OBJECTIVE: To investigate the efficacy of a smartphone-based Chinese culture-adapted DCBT-I application (app) for insomnia compared with sleep education using the same app. DESIGN, SETTING, AND PARTICIPANTS: This was a single-blinded, randomized clinical trial conducted from March 2021 to January 2022. Screening and randomization were conducted at Peking University First Hospital. Follow-up visits were performed online or in the same hospital. After assessing for eligibility, eligible participants were enrolled and allocated (1:1) to DCBT-I or sleep education groups. Data were analyzed from January to February 2022. INTERVENTIONS: A Chinese smartphone-based app with the same interface was used in both DCBT-I and sleep education groups over 6 weeks, with 1-, 3-, and 6-month follow-ups. MAIN OUTCOMES AND MEASURES: The primary outcome was Insomnia Severity Index (ISI) scores with the intention-to-treat principle. Secondary and exploratory outcomes included sleep diary measures; self-reported scales assessing dysfunctional beliefs about sleep, mental health, and quality of life; and smart bracelet measures. RESULTS: Of 82 participants (mean [SD] age, 49.67 [14.49] years; 61 [74.4%] females), with 41 randomized to sleep education and 41 randomized to DCBT-I; 77 participants completed the 6-week intervention (39 participants in the sleep education group and 38 participants in the DCBT-I group; full analysis data set) and 73 completed the 6-month follow-up (per protocol data set). Mean (SD) ISI scores in the DCBT-I group were significantly lower than those in the sleep education group after the 6-week intervention (12.7 [4.8] points vs 14.9 [5.0] points; Cohen d = 0.458; P = .048) and at the 3-month follow-up (12.1 [5.4] points vs 14.8 [5.5] points; Cohen d = 0.489; P = .04). There were significant improvements from before to after the intervention for both the sleep education and DCBT-I groups, with large effect sizes(sleep education: d = 1.13; DCBT-I: d = 1.71). Some of the sleep diary measures and self-reported scales showed more improvements in the DCBT-I group than sleep education group, such as total sleep time (mean [SD]: 3 months, 403.9 [57.6] minutes vs 363.2 [72.3] minutes; 6 months, 420.3 [58.0] minutes vs 389.7 [59.4] minutes) and sleep efficiency (mean [SD]: 3 months, 87.4% [8.3%] vs 76.7% [12.1%]; 6 months, 87.5% [8.2%] vs 78.1% [10.9%]). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the smartphone-based Chinese culture-adapted DCBT-I improved insomnia severity compared with sleep education. Future multicenter clinical trials with large sample sizes are needed to validate its effectiveness in the Chinese population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04779372.
99Efficacy of Digital Cognitive Behavioral Therapy for the Treatment of Insomnia Symptoms Among Pregnant Women: A Randomized Clinical Trial.PubMed
Jennifer N Felder, Elissa S Epel, John Neuhaus, et al.
JAMA Psychiatry. 2020 May 1;77(5):484-492. doi: 10.1001/jamapsychiatry.2019.4491.
IMPORTANCE: Despite the prevalence and adverse consequences of prenatal insomnia, a paucity of research is available regarding interventions to improve insomnia symptoms during pregnancy. OBJECTIVE: To test the efficacy of digital cognitive behavioral therapy for insomnia (CBT-I) compared with standard treatment among pregnant women with insomnia symptoms. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial enrolled pregnant women from November 23, 2016, to May 22, 2018. Of the 2258 women assessed for eligibility using an online self-report questionnaire, 208 were randomized to receive digital CBT-I (n = 105) or standard treatment (n = 103) for insomnia. Participants were pregnant up to 28 weeks' gestation, and they either had elevated insomnia symptom severity or met the criteria for insomnia caseness as determined by self-report questionnaires. Participants completed outcome measures at 10 weeks (postintervention) and 18 weeks (follow-up) after randomization. All study visits were completed remotely, and the intervention was delivered digitally. Data were analyzed between December 12, 2018, and July 2, 2019. INTERVENTIONS: Digital CBT-I consisted of 6 weekly sessions of approximately 20 minutes each. Standard treatment reflected standard care. Women receiving standard treatment had no limits placed on the receipt of nonstudy treatments, including medication and psychotherapy. MAIN OUTCOMES AND MEASURES: All outcomes were assessed remotely using self-report questionnaires administered via online survey. The primary outcome was the change in insomnia symptom severity (measured by the Insomnia Severity Index) from baseline to postintervention. Secondary outcomes were sleep efficiency and nightly sleep duration (defined by sleep diary), global sleep quality (measured by the Pittsburgh Sleep Quality Index), depressive symptom severity (measured by the Edinburgh Postnatal Depression Scale), and anxiety symptom severity (measured by the Generalized Anxiety Disorder Scale-7). For each outcome, we also examined the change from baseline to follow-up. RESULTS: The 208 participants had a mean (SD) age of 33.6 (3.7) years and a mean (SD) gestational age of 17.6 (6.3) weeks at baseline. Most of the participants were white (138 [66.3%]), married or cohabiting (196 [94.2%]), had a college degree (180 [86.5%]), and earned $100 000 or more per year (141 [67.8%]). Women randomized to receive digital CBT-I experienced statistically significantly greater improvements in insomnia symptom severity from baseline to postintervention compared with women randomized to receive standard treatment (time-by-group interaction, difference = -0.36; 95% CI, -0.48 to -0.23; χ2 = 29.8; P < .001; d = -1.03). Improvements from baseline to postintervention for all secondary outcomes, with the exception of sleep duration, were statistically significant. A similar pattern of results was evident for the change from baseline to follow-up. CONCLUSIONS AND RELEVANCE: In this trial, digital CBT was an effective, scalable, safe, and acceptable intervention for improving insomnia symptoms during pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02805998.
100Dispositional mindfulness moderates the relation between brooding rumination and sleep problems in adolescents.PubMed
Xiaoqian Yu, Joshua M Langberg, Stephen P Becker
Sleep Med. 2022 Feb;90:131-134. doi: 10.1016/j.sleep.2022.01.017. Epub 2022 Jan 24.
OBJECTIVES/BACKGROUND: This study examined whether dispositional mindfulness moderates the association between brooding rumination and sleep problems in adolescents with and without attention-deficit/hyperactivity disorder (ADHD). PARTICIPANTS/METHODS: Participants were 137 adolescents (ages 13-15 years; 64% male). Approximately half (47.4%; n = 65) were diagnosed with ADHD. Adolescents provided ratings of their dispositional mindfulness and brooding rumination. Both adolescents and parents provided ratings of adolescents' sleep problems. RESULTS: In analyses controlling for sex, race, study site, and group (ADHD vs. comparison), brooding rumination was associated with more adolescent- and parent-reported sleep problems only at low levels of dispositional mindfulness. This effect did not differ for adolescents with or without ADHD and was also unchanged when controlling for internalizing psychopathology symptoms. CONCLUSIONS: Our findings showed that dispositional mindfulness might buffer against the negative impact of brooding rumination on adolescent sleep. These findings may have important clinical implications and underscore the potential benefit of including mindfulness and other cognitive-behavioral approaches when treating sleep problems in adolescents.
101Using Mindfulness for the Treatment of Insomnia.PubMed
Jason C Ong, Christine E Smith
Curr Sleep Med Rep. 2017 Jun;3(2):57-65. doi: 10.1007/s40675-017-0068-1. Epub 2017 Apr 29.
PURPOSE OF REVIEW: The goal of this review is to provide an update on the use of mindfulness meditation for the treatment of insomnia, including conceptual models and empirical evidence from randomized controlled trials. RECENT FINDINGS: A metacognitive model of insomnia has been proposed as a conceptual model to explain the application of mindfulness principles for reducing insomnia-related arousal. Furthermore, the evidence base for mindfulness-based therapies has grown with the results of several randomized controlled trials published in the past three years. Treatment effects appear to be strongest on self-report measures compared to objective measures of sleep. SUMMARY: Treatment programs featuring mindfulness meditation appear to be viable treatment options for people with insomnia. Further research is needed to determine who is likely to benefit from mindfulness-based therapies and how these interventions work. Additionally, further work is needed to resolve issues related to the delivery and implementation of mindfulness-based therapies.
102The Effects of Mindfulness Meditation and Gentle Yoga on Spiritual Well-Being in Cancer Survivors: A Pilot Study.PubMed
Stephanie Bryan, Genevieve Zipp, Denise Breitkreuz
Altern Ther Health Med. 2021 May;27(3):32-38.
BACKGROUND: Cancer survivors face countless physiological and psychological challenges that affect their abilities and negatively impact their quality of life and general well-being. A biopsychosocial-spiritual approach to health management may be beneficial. PRIMARY STUDY OBJECTIVE: To assess the effect of gentle yoga and mindfulness meditation on spiritual well-being in cancer survivors. METHODS/DESIGN: This is a mixed methods, quasi-experimental pilot study providing 10 weeks of gentle yoga and mindfulness meditation twice per week to cancer survivors. SETTING: The intervention was provided at a South Florida university in the summer months. PARTICIPANTS: Ten cancer survivors self-selected to participate in the 10-week study; 2 participants did not complete the post-test data collection. INTERVENTION: Each class opened and closed with 5 to 6 minutes of nonmoving mindfulness meditation. The mindfulness meditation techniques included body scan, breath awareness, visualization, affirmation, and compassion meditations. The gentle yoga practice was a series of beginner yoga postures and stretches. The mindfulness meditation techniques of breath and body awareness during yoga created what is referred to as a "moving meditation" with yoga postures encompassing the movement portion. PRIMARY OUTCOME MEASURES: The Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being 12 Item Scale (FACIT-Sp-12) and 2 open-ended questions. RESULTS: The FACIT-Sp-12 pre- and post-test data were analyzed using a paired samples t test. There was a significant improvement in overall spiritual well-being from pretest (μ = 34.25, SD = 7.28) to post-test (μ = 39.50, SD = 7.91); t (7) = -4.02, P = 0.003. Qualitative data: the participants reported improvements in various aspects of spirituality, fitness, emotional well-being, stress management, sleep, and a sense of social connectedness. CONCLUSION: The biopsychosocial-spiritual approach to health care may play a vital role in addressing the well-being of the whole person. Gentle yoga and mindfulness meditation can result in improvement in measures of spiritual well-being among cancer survivors and may be further utilized as an accessible intervention for those who are suffering throughout all segments of society.
103Reducing cognitive arousal and sleep effort alleviates insomnia and depression in pregnant women with DSM-5 insomnia disorder treated with a mindfulness sleep program.PubMed
David A Kalmbach, Philip Cheng, Anthony N Reffi, et al.
Sleep Adv. 2023 Aug 5;4(1):zpad031. doi: 10.1093/sleepadvances/zpad031. eCollection 2023.
OBJECTIVES: Combining mindfulness with behavioral sleep strategies has been found to alleviate symptoms of insomnia and depression during pregnancy, but mechanisms for this treatment approach remain unclear. The present study examined nocturnal cognitive arousal and sleep effort as potential treatment mechanisms for alleviating insomnia and depression via a mindfulness sleep program for pregnant women. METHODS: Secondary analysis from a proof-of-concept trial of 12 pregnant women with DSM-5 insomnia disorder who were treated with Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness framework. Data were collected across eight weekly assessments: pretreatment, six sessions, and posttreatment. Measures included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale's cognitive factor (PSASC), and the Glasgow sleep effort scale (GSES). We used linear mixed modeling to test cognitive arousal and sleep effort as concurrent and prospective predictors of insomnia and depression. RESULTS: Most patients reported high cognitive arousal before PUMAS (75.0%), which decreased to 8.3% after treatment. All insomnia remitters reported low cognitive arousal after treatment, whereas half of nonremitters continued reporting high cognitive arousal. Both nocturnal cognitive arousal and sleep effort were associated with same-week changes in insomnia throughout treatment, and sleep effort yielded a prospective effect on insomnia. Lower levels of nocturnal cognitive arousal and sleep effort prospectively predicted reductions in depression. CONCLUSIONS: The present study offers preliminary evidence that reducing sleep effort and nocturnal cognitive arousal may serve as key mechanisms for alleviating insomnia and depression via mindfulness-based insomnia therapy. ClinicalTrials.gov ID: NCT04443959.
104Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial.PubMed
David S Black, Gillian A O'Reilly, Richard Olmstead, et al.
JAMA Intern Med. 2015 Apr;175(4):494-501. doi: 10.1001/jamainternmed.2014.8081.
IMPORTANCE: Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep. OBJECTIVE: To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5). INTERVENTIONS: A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework. MAIN OUTCOMES AND MEASURES: The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)-κB. RESULTS: Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05). CONCLUSIONS AND RELEVANCE: The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01534338.
105The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials.PubMed
Heather L Rusch, Michael Rosario, Lisa M Levison, et al.
Ann N Y Acad Sci. 2019 Jun;1445(1):5-16. doi: 10.1111/nyas.13996. Epub 2018 Dec 21.
There is a growing interest in the effectiveness of mindfulness meditation for sleep disturbed populations. Our study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. To assess for relative efficacy, comparator groups were restricted to specific active controls (such as evidenced-based sleep treatments) and nonspecific active controls (such as time/attention-matched interventions to control for placebo effects), which were analyzed separately. From 3303 total records, 18 trials with 1654 participants were included. We determined the strength of evidence using four domains (risk of bias, directness of outcome measures, consistency of results, and precision of results). At posttreatment and follow-up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls (ES 0.03 (95% CI -0.43 to 0.49)) and (ES -0.14 (95% CI -0.62 to 0.34)), respectively. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention (ES 0.33 (95% CI 0.17-0.48)) and at follow-up (ES 0.54 (95% CI 0.24-0.84)). These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
106Mindfulness-based interventions: an overall review.PubMed
Dexing Zhang, Eric K P Lee, Eva C W Mak, et al.
Br Med Bull. 2021 Jun 10;138(1):41-57. doi: 10.1093/bmb/ldab005.
INTRODUCTION: This is an overall review on mindfulness-based interventions (MBIs). SOURCES OF DATA: We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including 'mindfulness', 'meditation', and 'review', 'meta-analysis' or their variations. AREAS OF AGREEMENT: MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions. AREAS OF CONTROVERSY: Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations. GROWING POINTS: Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed. AREAS TIMELY FOR DEVELOPING RESEARCH: More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.
107A mindfulness meditation mobile app improves depression and anxiety in adults with sleep disturbance: Analysis from a randomized controlled trial.PubMed
Jennifer Huberty, Megan E Puzia, Jeni Green, et al.
Gen Hosp Psychiatry. 2021 Nov-Dec;73:30-37. doi: 10.1016/j.genhosppsych.2021.09.004. Epub 2021 Sep 11.
OBJECTIVE: The objective of this study was to 1) determine the effects of a meditation app on depression and anxiety in adults with sleep disturbance, and 2) explore the potential mediating effects of fatigue, daytime sleepiness, and pre-sleep arousal on the relationship between use of the meditation app and changes in depression and anxiety. METHODS: Participants were 239 adults with elevated insomnia symptoms (i.e., scores ≥ 10 on the Insomnia Severity Index) and limited or no previous experience with meditation. Depression, anxiety, fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, four weeks, and eight weeks. Repeated-measures ANCOVAs assessed intervention effects on depression and anxiety. Mediation models were estimated using the PROCESS macro. RESULTS: Participants in the meditation group had more improvement in depression and anxiety symptoms during the intervention period than did those in the control group. Changes in somatic and cognitive pre-sleep arousal at mid-intervention fully mediated effects on depression and partially mediated effects on anxiety. There were no significant indirect effects of fatigue and daytime-sleepiness on changes in mental health. CONCLUSIONS: A meditation app may improve depression and anxiety in adults with sleep disturbance, with effects being driven by improvements in pre-sleep arousal. Future studies should consider targeting pre-sleep arousal to improve mental health in this population.
108Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy.PubMed
David A Kalmbach, Thomas Roth, Philip Cheng, et al.
Sleep Health. 2020 Apr;6(2):185-191. doi: 10.1016/j.sleh.2019.11.011. Epub 2020 Mar 4.
BACKGROUND: Insomnia and depression are highly prevalent perinatal complications. Ruminating on stress is etiologically implicated in both disorders, and ruminating while trying to fall asleep has been linked to insomnia and depression during pregnancy. Incompatible with rumination is everyday mindfulness, i.e., living with intentional and nonjudgmental awareness of internal and external experiences in the present moment. Responding to stress mindfully may protect against stress-related perinatal complications such as insomnia and depression. The present study described the association between everyday mindfulness and nocturnal rumination, and examined whether these trait characteristics were independently related to perinatal insomnia and depression. METHODS: Cross-sectional and secondary analysis of existing data from 65 pregnant women recruited from a multisite hospital in Metro Detroit, MI, USA. Subjects completed online surveys including the Insomnia Severity Index, Edinburgh Postnatal Depression Scale, Presleep Arousal Scale, and the revised Cognitive and Affective Mindfulness Scale. RESULTS: Over half (53.8%) of women screened positive for clinical insomnia and 12.3% screened positive for major depression. Women high in mindfulness, relative to those low in mindfulness, reported less nocturnal rumination (Cohen's d=1.16), insomnia symptoms (Cohen's d=1.24), and depressive symptoms (Cohen's d=1.35). Multivariate linear regression revealed that both mindfulness (β=-.24, p=.03) and rumination (β=.38, p<.01) were independently associated with insomnia. Similarly, a multivariate model showed that mindfulness (β=-.41, p<.001) and rumination (β=.35, p<.01) were independently associated with depression. CONCLUSIONS: Ruminating in bed at night is strongly associated with insomnia and depression during pregnancy, whereas mindfulness may potentially protect against these stress-related perinatal complications.
109Prenatal Symptom Cluster of Psychopathology and Associations With Mindfulness and Rumination: A Network Analysis.PubMed
Yaoyao Sun, Qingyi Chen, Yanyan Li, et al.
J Nerv Ment Dis. 2022 Jul 1;210(7):515-524. doi: 10.1097/NMD.0000000000001485. Epub 2022 Jan 27.
The present study aimed to examine the interrelationships of prenatal psychopathology (specifically symptom cluster), dispositional mindfulness, and rumination using network analysis. Network analysis estimates the links between symptoms and can evaluate the presence and strength of the links. A total of 1122 pregnant women were recruited from a tertiary hospital in China. Psychopathology symptoms (including anxiety, depression, stress, fatigue, sleep, fear of childbirth [FOC], and memory problems) were assessed and used along with mindfulness and rumination to construct networks of association using R. Results illustrated five communities within the network. Anxiety resulted in the highest strength of centrality followed by two symptoms: FOC and retrospective memory. Paths showed that mindfulness was directly connected to depression, prospective memory, retrospective memory, and lack of positive anticipation in FOC, whereas mindfulness was connected indirectly through rumination to anxiety, fatigue, stress, and sleep problems. The findings reinforce that anxiety is a key symptom of prenatal psychopathology and requires priority consideration. The direct associations between mindfulness and prenatal psychopathology symptoms provide potential targets for future mindfulness-based interventions, and mindfulness reducing rumination thus in turn decrease anxiety, suggesting potential mediating mechanism of mindfulness.
110Mindfulness-based Cognitive Therapy to Improve Sleep Quality in Older Adults with Insomnia.PubMed
Manuel Camino, Encarnacion Satorres, Iraida Delhom, et al.
Psychosoc Interv. 2022 Jul 20;31(3):159-167. doi: 10.5093/pi2022a12. eCollection 2022 Jul.
There is a high prevalence of insomnia in older adults, which has negative consequences for their well-being and quality of life. The recommendation for first-line treatments is to administer non-pharmacological interventions. The objective of this research was to verify the effectiveness of Mindfulness-Based Cognitive Therapy in older adults with subclinical and moderate insomnia, studying its impact on sleep quality. One hundred and six older adults participated and were assigned to the subclinical insomnia ( = 50) or moderate insomnia ( = 56) groups; subsequently, they were randomly assigned to the control and intervention groups. Subjects were evaluated at two times with the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. Significant results were obtained on both scales, with a reduction in insomnia symptoms in the subclinical and moderate intervention groups. The administration of a treatment that combines mindfulness and cognitive therapy is effective for treating insomnia in older adults.
111The effect of mindfulness-based stress reduction on anxiety and sleep quality in informal family caregivers of cancer patients: a randomized controlled trial.PubMed
Sayedeh Farkhondeh Safavi, Hakimeh Vahedparast, Batool Amiri, et al.
BMC Nurs. 2025 Nov 6;24(1):1375. doi: 10.1186/s12912-025-04063-z.
BACKGROUND: Informal caregivers play a crucial supportive role throughout the course of illnesses, particularly in patients with cancer. Following a cancer diagnosis, informal caregivers often experience substantial psychological, physical, and social stress, which may lead to conditions such as anxiety and sleep disturbances. Therefore, implementing interventions aimed at reducing anxiety and improving sleep quality is essential. The present study aims to assess the impact of mindfulness-based stress reduction (MBSR) training on anxiety and sleep quality among informal caregivers of patients with cancer. METHODS: This randomized controlled trial was conducted in 2024 on 66 informal caregivers of cancer patients in Bushehr, Iran. Participants were selected using convenience sampling method and then randomly assigned to either the intervention or control group. The intervention group received eight sessions of MBSR training, each lasting 120 min, which included mindfulness meditation, body scan, and mindful breathing exercises. The control group received no intervention. Data were collected using a demographic form, Spielberger State-Trait Anxiety Inventory (STAI), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS 26.0 through descriptive statistics, independent t-test, paired t-test, and ANCOVA at a significance level of 0.05. RESULTS: The results indicated a statistically significant difference between the two groups regarding both anxiety and sleep quality after the intervention (anxiety: < 0.001, ηp² = 0.22; sleep quality: = 0.004, ηp² = 0.12). In the intervention group, the mean anxiety score decreased from 105.94 ± 11.73 (pretest) to 80.39 ± 13.68 (one-month follow-up), and the mean sleep quality score (PSQI) improved from 11.26 ± 2.65 to 9.94 ± 2.09. In contrast, the control group showed no significant improvement. CONCLUSION: The results of this study suggest that mindfulness-based interventions may help reduce anxiety and improve sleep quality in female informal caregivers of cancer patients. This intervention shows promise as a potentially effective approach for promoting caregivers’ mental health. However, the findings are only applicable to women and cannot be generalized to male caregivers, who may experience different social and emotional burdens. In addition, the use of a passive control group and the dual role of the instructor (intervention delivery and homework monitoring) represent important limitations. Furthermore, due to the small sample size, use of convenience sampling, and partial blinding, the results should be interpreted with caution. Future research should include both genders, use active control conditions, and conduct larger long-term randomized trials to confirm these outcomes and assess their generalizability across different settings. TRIAL REGISTRATION: IRCT, IRCT20240310061244N1, registered prospectively on 2024-04-30. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-025-04063-z.
112Is it Time to Include Wearable Sleep Trackers in the Applied Psychologists' Toolbox?PubMed
Luca Menghini, Cristian Balducci, Massimiliano de Zambotti
Span J Psychol. 2024 Feb 27;27:e8. doi: 10.1017/SJP.2024.8.
Wearable sleep trackers are increasingly used in applied psychology. Particularly, the recent boom in the fitness tracking industry has resulted in a number of relatively inexpensive consumer-oriented devices that further enlarge the potential applications of ambulatory sleep monitoring. While being largely positioned as wellness tools, wearable sleep trackers could be considered useful health devices supported by a growing number of independent peer-reviewed studies evaluating their accuracy. The inclusion of sensors that monitor cardiorespiratory physiology, diurnal activity data, and other environmental signals allows for a comprehensive and multidimensional approach to sleep health and its impact on psychological well-being. Moreover, the increasingly common combination of wearable trackers and experience sampling methods has the potential to uncover within-individual processes linking sleep to daily experiences, behaviors, and other psychosocial factors. Here, we provide a concise overview of the state-of-the-art, challenges, and opportunities of using wearable sleep-tracking technology in applied psychology. Specifically, we review key device profiles, capabilities, and limitations. By providing representative examples, we highlight how scholars and practitioners can fully exploit the potential of wearable sleep trackers while being aware of the most critical pitfalls characterizing these devices. Overall, consumer wearable sleep trackers are increasingly recognized as a valuable method to investigate, assess, and improve sleep health. Incorporating such devices in research and professional practice might significantly improve the quantity and quality of the collected information while opening the possibility of involving large samples over representative time periods. However, a rigorous and informed approach to their use is necessary.
113Wearable Sleep Technology in Clinical and Research Settings.PubMed
Massimiliano de Zambotti, Nicola Cellini, Aimée Goldstone, et al.
Med Sci Sports Exerc. 2019 Jul;51(7):1538-1557. doi: 10.1249/MSS.0000000000001947.
: The accurate assessment of sleep is critical to better understand and evaluate its role in health and disease. The boom in wearable technology is part of the digital health revolution and is producing many novel, highly sophisticated and relatively inexpensive consumer devices collecting data from multiple sensors and claiming to extract information about users' behaviors, including sleep. These devices are now able to capture different biosignals for determining, for example, HR and its variability, skin conductance, and temperature, in addition to activity. They perform 24/7, generating overwhelmingly large data sets (big data), with the potential of offering an unprecedented window on users' health. Unfortunately, little guidance exists within and outside the scientific sleep community for their use, leading to confusion and controversy about their validity and application. The current state-of-the-art review aims to highlight use, validation and utility of consumer wearable sleep-trackers in clinical practice and research. Guidelines for a standardized assessment of device performance is deemed necessary, and several critical factors (proprietary algorithms, device malfunction, firmware updates) need to be considered before using these devices in clinical and sleep research protocols. Ultimately, wearable sleep technology holds promise for advancing understanding of sleep health; however, a careful path forward needs to be navigated, understanding the benefits and pitfalls of this technology as applied in sleep research and clinical sleep medicine.
114Consumer sleep tracking devices: a review of mechanisms, validity and utility.PubMed
Bhanu Prakash Kolla, Subir Mansukhani, Meghna P Mansukhani
Expert Rev Med Devices. 2016 May;13(5):497-506. doi: 10.1586/17434440.2016.1171708. Epub 2016 Apr 18.
Consumer sleep tracking devices such as fitness trackers and smartphone apps have become increasingly popular. These devices claim to measure the sleep duration of their users and in some cases purport to measure sleep quality and awaken users from light sleep, potentially improving overall sleep. Most of these devices appear to utilize data generated from in-built accelerometers to determine sleep parameters but the exact mechanisms and algorithms are proprietary. The growing literature comparing these devices against polysomnography/actigraphy shows that they tend to underestimate sleep disruptions and overestimate total sleep times and sleep efficiency in normal subjects. In this review, we evaluate the current literature comparing the accuracy of consumer sleep tracking devices against more conventional methods used to measure sleep duration and quality. We discuss the current technology that these devices utilize as well as summarize the value of these devices in clinical evaluations and their potential limitations.
115Accuracy of 11 Wearable, Nearable, and Airable Consumer Sleep Trackers: Prospective Multicenter Validation Study.PubMed
Taeyoung Lee, Younghoon Cho, Kwang Su Cha, et al.
JMIR Mhealth Uhealth. 2023 Nov 2;11:e50983. doi: 10.2196/50983.
BACKGROUND: Consumer sleep trackers (CSTs) have gained significant popularity because they enable individuals to conveniently monitor and analyze their sleep. However, limited studies have comprehensively validated the performance of widely used CSTs. Our study therefore investigated popular CSTs based on various biosignals and algorithms by assessing the agreement with polysomnography. OBJECTIVE: This study aimed to validate the accuracy of various types of CSTs through a comparison with in-lab polysomnography. Additionally, by including widely used CSTs and conducting a multicenter study with a large sample size, this study seeks to provide comprehensive insights into the performance and applicability of these CSTs for sleep monitoring in a hospital environment. METHODS: The study analyzed 11 commercially available CSTs, including 5 wearables (Google Pixel Watch, Galaxy Watch 5, Fitbit Sense 2, Apple Watch 8, and Oura Ring 3), 3 nearables (Withings Sleep Tracking Mat, Google Nest Hub 2, and Amazon Halo Rise), and 3 airables (SleepRoutine, SleepScore, and Pillow). The 11 CSTs were divided into 2 groups, ensuring maximum inclusion while avoiding interference between the CSTs within each group. Each group (comprising 8 CSTs) was also compared via polysomnography. RESULTS: The study enrolled 75 participants from a tertiary hospital and a primary sleep-specialized clinic in Korea. Across the 2 centers, we collected a total of 3890 hours of sleep sessions based on 11 CSTs, along with 543 hours of polysomnography recordings. Each CST sleep recording covered an average of 353 hours. We analyzed a total of 349,114 epochs from the 11 CSTs compared with polysomnography, where epoch-by-epoch agreement in sleep stage classification showed substantial performance variation. More specifically, the highest macro F1 score was 0.69, while the lowest macro F1 score was 0.26. Various sleep trackers exhibited diverse performances across sleep stages, with SleepRoutine excelling in the wake and rapid eye movement stages, and wearables like Google Pixel Watch and Fitbit Sense 2 showing superiority in the deep stage. There was a distinct trend in sleep measure estimation according to the type of device. Wearables showed high proportional bias in sleep efficiency, while nearables exhibited high proportional bias in sleep latency. Subgroup analyses of sleep trackers revealed variations in macro F1 scores based on factors, such as BMI, sleep efficiency, and apnea-hypopnea index, while the differences between male and female subgroups were minimal. CONCLUSIONS: Our study showed that among the 11 CSTs examined, specific CSTs showed substantial agreement with polysomnography, indicating their potential application in sleep monitoring, while other CSTs were partially consistent with polysomnography. This study offers insights into the strengths of CSTs within the 3 different classes for individuals interested in wellness who wish to understand and proactively manage their own sleep.
116State of the science and recommendations for using wearable technology in sleep and circadian research.PubMed
Massimiliano de Zambotti, Cathy Goldstein, Jesse Cook, et al.
Sleep. 2024 Apr 12;47(4). doi: 10.1093/sleep/zsad325.
Wearable sleep-tracking technology is of growing use in the sleep and circadian fields, including for applications across other disciplines, inclusive of a variety of disease states. Patients increasingly present sleep data derived from their wearable devices to their providers and the ever-increasing availability of commercial devices and new-generation research/clinical tools has led to the wide adoption of wearables in research, which has become even more relevant given the discontinuation of the Philips Respironics Actiwatch. Standards for evaluating the performance of wearable sleep-tracking devices have been introduced and the available evidence suggests that consumer-grade devices exceed the performance of traditional actigraphy in assessing sleep as defined by polysomnogram. However, clear limitations exist, for example, the misclassification of wakefulness during the sleep period, problems with sleep tracking outside of the main sleep bout or nighttime period, artifacts, and unclear translation of performance to individuals with certain characteristics or comorbidities. This is of particular relevance when person-specific factors (like skin color or obesity) negatively impact sensor performance with the potential downstream impact of augmenting already existing healthcare disparities. However, wearable sleep-tracking technology holds great promise for our field, given features distinct from traditional actigraphy such as measurement of autonomic parameters, estimation of circadian features, and the potential to integrate other self-reported, objective, and passively recorded health indicators. Scientists face numerous decision points and barriers when incorporating traditional actigraphy, consumer-grade multi-sensor devices, or contemporary research/clinical-grade sleep trackers into their research. Considerations include wearable device capabilities and performance, target population and goals of the study, wearable device outputs and availability of raw and aggregate data, and data extraction, processing, and analysis. Given the difficulties in the implementation and utilization of wearable sleep-tracking technology in real-world research and clinical settings, the following State of the Science review requested by the Sleep Research Society aims to address the following questions. What data can wearable sleep-tracking devices provide? How accurate are these data? What should be taken into account when incorporating wearable sleep-tracking devices into research? These outstanding questions and surrounding considerations motivated this work, outlining practical recommendations for using wearable technology in sleep and circadian research.
117Consumer-grade sleep trackers are still not up to par compared to polysomnography.PubMed
Kyubo Kim, Do-Yang Park, Yong Jae Song, et al.
Sleep Breath. 2022 Dec;26(4):1573-1582. doi: 10.1007/s11325-021-02493-y. Epub 2021 Nov 5.
PURPOSE: Although polysomnography (PSG) is the gold standard for monitoring sleep, it has many limitations. We aimed to prospectively determine the validity of wearable sleep-tracking devices and smartphone applications by comparing the data to that of PSGs. METHODS: Patients who underwent one night of attended PSG at a single institution from January, 2015 to July 2019 were recruited. Either a sleep application or wearable device was used simultaneously while undergoing PSG. Nine smartphone applications and three wearable devices were assessed. RESULTS: We analyzed the results of 495 cases of smartphone applications and 170 cases of wearables by comparing each against PSG. None of the tested applications were able to show a statistically significant correlation between sleep efficiency, durations of wake time, light sleep or deep sleep with PSG. Snore time correlated well in both of the two applications which provided such information. Deep sleep duration and WASO measured by two of the three wearable devices correlated significantly with PSG. Even after controlling for transition count and moving count, the correlation indices of the wearables did not increase, suggesting that the algorithms used by the wearables were not largely affected by tossing and turning. CONCLUSIONS: Most of the applications tested in this study showed poor validity, while wearable devices mildly correlated with PSG. An effective use for these devices may be as a tool to identify the change seen in an individual's sleep patterns on a day-to-day basis, instead of as a method of detecting absolute measurements.
118The Validity of a New Consumer-Targeted Wrist Device in Sleep Measurement: An Overnight Comparison Against Polysomnography in Children and Adolescents.PubMed
Anu-Katriina Pesonen, Liisa Kuula
J Clin Sleep Med. 2018 Apr 15;14(4):585-591. doi: 10.5664/jcsm.7050.
STUDY OBJECTIVES: The validity of consumer-targeted wrist-worn sleep measurement systems has been little studied in children and adolescents. We examined the validity of a new fitness tracker (PFT) manufactured by Polar Electro Oy and the previously validated Actiwatch 2 (AW2) from Philips Respironics against polysomnography (PSG) in children and adolescents. METHODS: Seventeen children (age 11.0 ± 0.8 years) and 17 adolescents (age 17.8 ± 1.8 years) wore the PFT and AW2 concurrently with an ambulatory PSG in their own home for 1 night. We compared sleep onset, offset, sleep interval (time from sleep on to offset), actual sleep time (time scored as sleep between sleep on and offset), and wake after sleep onset (WASO) between accelerometers and PSG. Sensitivity, specificity, and accuracy were calculated from the epoch-by-epoch data. RESULTS: Both devices performed adequately against PSG, with excellent sensitivity for both age groups (> 0.91). In terms of specificity, the PFT was adequate in both groups (> 0.77), and AW2 adequate in children (0.68) and poor in adolescents (0.58). In the younger group, the PFT underestimated actual sleep time by 29.9 minutes and AW2 underestimated actual sleep time by 43.6 minutes. Both overestimated WASO, PFT by 24.4 minutes and AW2 by 20.9 minutes. In the older group, both devices underestimated actual sleep time (PFT by 20.6 minutes and AW2 by 26.8 minutes) and overestimated WASO (PFT by 12.5 minutes and AW2 by 14.3 minutes). Both devices were accurate in defining sleep onset. CONCLUSIONS: This study suggests that this consumer-targeted wrist-worn device performs as well as, or even better than, the previously validated AW2 against PSG in children and adolescents. Both devices underestimated sleep but to a lesser extent than seen in many previous validation studies on research-targeted accelerometers.
119Validation of Fitbit Charge 4 for assessing sleep in Chinese patients with chronic insomnia: A comparison against polysomnography and actigraphy.PubMed
Xiaofang Dong, Sen Yang, Yuanli Guo, et al.
PLoS One. 2022 Oct 18;17(10):e0275287. doi: 10.1371/journal.pone.0275287. eCollection 2022.
Our research aims to assess the performance of a new generation of consumer activity trackers (Fitbit Charge 4TM: FBC) to measure sleep variables and sleep stage classifications in patients with chronic insomnia, compared to polysomnography (PSG) and a widely used actigraph (Actiwatch Spectrum Pro: AWS). We recruited 37 participants, all diagnosed with chronic insomnia disorder, for one night of sleep monitoring in a sleep laboratory using PSG, AWS, and FBC. Epoch-by-epoch analysis along with Bland-Altman plots was used to evaluate FBC and AWS against PSG for sleep-wake detection and sleep variables: total sleep time (TST), sleep efficiency (SE), waking after sleep onset (WASO), and sleep onset latency (SOL). FBC sleep stage classification of light sleep (LS), deep sleep (DS), and rapid eye movement (REM) was also compared to that of PSG. When compared with PSG, FBC notably underestimated DS (-41.4, p < 0.0001) and SE (-4.9%, p = 0.0016), while remarkably overestimating LS (37.7, p = 0.0012). However, the TST, WASO, and SOL assessed by FBC presented no significant difference from that assessed by PSG. Compared with PSG, AWS and FBC showed great accuracy (86.9% vs. 86.5%) and sensitivity (detecting sleep; 92.6% vs. 89.9%), but comparatively poor specificity (detecting wake; 35.7% vs. 62.2%). Both devices showed better accuracy in assessing sleep than wakefulness, with the same sensitivity but statistically different specificity. FBC supplied equivalent parameters estimation as AWS in detecting sleep variables except for SE. This research shows that FBC cannot replace PSG thoroughly in the quantification of sleep variables and classification of sleep stages in Chinese patients with chronic insomnia; however, the user-friendly and low-cost wearables do show some comparable functions. Whether FBC can serve as a substitute for actigraphy and PSG in patients with chronic insomnia needs further investigation.
120Performance of consumer wrist-worn sleep tracking devices compared to polysomnography: a meta-analysis.PubMed
Young Jeong Lee, Jae Yong Lee, Jae Hoon Cho, et al.
J Clin Sleep Med. 2025 Mar 1;21(3):573-582. doi: 10.5664/jcsm.11460.
STUDY OBJECTIVES: The use of sleep tracking devices is increasing as people become more aware of the importance of sleep and interested in monitoring their patterns. With many devices on the market, we conducted a meta-analysis comparing sleep scoring data from consumer wrist-worn sleep tracking devices with polysomnography to validate the accuracy of these devices. METHODS: We retrieved studies from the databases of SCOPUS, EMBASE, Cochrane Library, PubMed, Web of Science, and KoreaMed and OVID Medline up to March 2024. We compared personal data about participants and information on objective sleep parameters. RESULTS: From 24 studies, data of 798 patient using Fitbit, Jawbone, myCadian watch, WHOOP strap, Garmin, Basis B1, Zulu Watch, Huami Arc, E4 wristband, Fatigue Science Readiband, Apple Watch, or Xiaomi Mi Band 5 were analyzed. There were significant differences in total sleep time (mean difference, -16.854; 95% confidence interval, [-26.332; -7.375]), sleep efficiency (mean difference, -4.691; 95% confidence interval, [-7.079; -2.302]), sleep latency (mean difference, 2.574; 95% confidence interval, [0.606; 4.542]), and wake after sleep onset (mean difference, 13.255; 95% confidence interval, [4.522; 21.988]) between all consumer sleep tracking devices and polysomnography. In subgroup analysis, there was no significant difference in wake after sleep onset between Fitbit and polysomnography. There was also no significant difference in sleep latency between other devices and polysomnography. Fitbit measured sleep latency longer than other devices, and other devices measured wake after sleep onset longer. Based on Begg and Egger's test, there was no publication bias in total sleep time and sleep efficiency. CONCLUSIONS: Wrist-worn sleep tracking devices, although popular, are not as reliable as polysomnography in measuring key sleep parameters such as total sleep time, sleep efficiency, and sleep latency. Physicians and consumers should be aware of their limitations and interpret results carefully, though they can still be useful for tracking general sleep patterns. Further improvements and clinical studies are needed to enhance their accuracy. CITATION: Lee YJ, Lee JY, Cho JH, Kang YJ, Choi JH. Performance of consumer wrist-worn sleep tracking devices compared to polysomnography: a meta-analysis. 2025;21(3):573-582.
121World Sleep Society recommendations for the use of wearable consumer health trackers that monitor sleep.PubMed
Michael Wl Chee, Mathias Baumert, Hannah Scott, et al.
Sleep Med. 2025 Jul;131:106506. doi: 10.1016/j.sleep.2025.106506. Epub 2025 Apr 5.
Wearable consumer health trackers (CHTs) are increasingly used for sleep monitoring, yet their utility remains debated within the sleep community. To navigate these perspectives, we propose pragmatic, actionable recommendations for users, clinicians, researchers, and manufacturers to support CHT usage and development. We provide an overview of the evolution of multi-sensor CHTs, detailing common sensors and sleep-relevant metrics. We advocate for standardized 'fundamental sleep measures' across manufacturers, distinguishing these from proprietary exploratory metrics with future potential. We outline best practices for using CHT-derived sleep data in healthy individuals while addressing current device limitations. Additionally, we explore their role in evaluating and managing individuals at risk for or diagnosed with insomnia, sleep apnea, or circadian rhythm sleep-wake disorders. Guidance is provided on device selection to align with their intended use and on conducting and interpreting performance evaluation studies. Collaboration with manufacturers is needed to balance feature comprehensiveness with clinical utility and usability. Finally, we examine challenges in integrating heterogeneous sleep data into clinical health records and discuss medical device certification for specific wearable CHT features. By addressing these issues, our recommendations aim to inform the usage of CHTs in the global community and to begin bridging the gap between consumer technology and clinical application, maximizing the potential of CHTs to enhance both personal and community sleep health.
122Oximetry-based devices in diagnosis of obstructive sleep apnea: A systematic review and meta-analysis.PubMed
Eder Leandro da Silva Dantas, Fernando Gustavo Stelzer, Wanderley Marques Bernardo, et al.
Sleep Med Rev. 2025 Oct;83:102139. doi: 10.1016/j.smrv.2025.102139. Epub 2025 Jul 22.
Obstructive sleep apnea (OSA) is a common disorder, associated with significant morbidity and mortality. Recently, several oximetry-based devices have been developed to assist with diagnosing OSA. Therefore, this study aims to evaluate the diagnostic performance of these tools compared to PSG. We included studies that evaluated oximetry-based devices in comparison to PSG for OSA diagnosis in adults. 18 selected studies were divided into two subgroups: consumer wearable and medical devices. Overall sensitivity was 97 % (95 % Confidence Interval [CI]: 96-97 %) and specificity, 63 % (95 % CI: 61-65. In the consumer wearable devices subgroup, sensitivity was 93 % (95 % CI: 90 - 96) and specificity, 63 % (95 % CI: 53 - 71). In the medical devices subgroup, sensitivity was also high as 97 % (95 % CI: 96-97) with a specificity of 63 % (95 % CI: 61-65). Accuracy measured by area under the curve and post-test probability were both 90 %. Oximetry-based devices demonstrate high sensitivity for ruling out OSA in high-risk adults. However, their low specificity raises concerns regarding potential unnecessary healthcare costs. Therefore, these devices may be considered for screening in high-risk individuals, provided that all positive results are confirmed by a gold-standard diagnostic method.
123Lifestyle Modification Using a Wearable Biometric Ring and Guided Feedback Improve Sleep and Exercise Behaviors: A 12-Month Randomized, Placebo-Controlled Study.PubMed
Jonathan D Browne, David M Boland, Jaxon T Baum, et al.
Front Physiol. 2021 Nov 25;12:777874. doi: 10.3389/fphys.2021.777874. eCollection 2021.
Wearable biometric monitoring devices (WBMD) show promise as a cutting edge means to improve health and prevent disease through increasing accountability. By regularly providing real-time quantitative data regarding activity, sleep quality, and recovery, users may become more aware of the impact that their lifestyle has on their health. The purpose of this study was to examine the efficacy of a biometric tracking ring on improving sleep quality and increasing physical fitness over a one-year period. Fifty-six participants received a biometric tracking ring and were placed in one of two groups. One group received a 3-month interactive behavioral modification intervention (INT) that was delivered virtually a smartphone app with guided text message feedback (GTF). The other received a 3-month non-directive wellness education control (CON). After three months, the INT group was divided into a long-term feedback group (LT-GTF) that continued to receive GTF for another nine months or short-term feedback group (ST-GTF) that stopped receiving GTF. Weight, body composition, and VOmax were assessed at baseline, 3months, and 12months for all participants and additionally at 6 and 9months for the ST-GTF and LT-GTF groups. To establish baseline measurements, sleep and physical activity data were collected daily over a 30-day period. Daily measurements were also conducted throughout the 12-month duration of the study. Over the first 3months, the INT group had significant (<0.001) improvements in sleep onset latency, daily step count, % time jogging, VOmax, body fat percentage, and heart rate variability (rMSSD HRV) compared to the CON group. Over the next 9months, the LT-GTF group continued to improve significantly (<0.001) in sleep onset latency, daily step count, % time jogging, VOmax, and rMSSD HRV. The ST-GTF group neither improved nor regressed over the latter 9months except for a small increase in sleep latency. Using a WBMD concomitantly with personalized education, encouragement, and feedback, elicits greater change than using a WBMD alone. Additionally, the improvements achieved from a short duration of personalized coaching are largely maintained with the continued use of a WBMD.
124Wearable Monitoring Captures Sleep Disturbances in Patients With Chronic Inflammatory Demyelinating Polyneuropathy.PubMed
Jan Voth, Charlotte von Gall, Noëmi Gmahl, et al.
J Peripher Nerv Syst. 2025 Dec;30(4):e70069. doi: 10.1111/jns.70069.
BACKGROUND AND AIMS: Previous studies suggest that patients with chronic inflammatory demyelinating polyneuropathy (CIDP) experience impaired sleep, contributing to fatigue. Traditional methods like polysomnography or questionnaires are resource-intensive and may not capture sleep in natural settings. We explored whether widely available consumer-grade smartwatches offer a feasible way to assess sleep quality in this population. METHODS: The Electronic Monitoring of Disease Activity in patients with CIDP (EMDA-CIDP) study was a prospective observational study conducted from January 2023 to July 2024 at the University Hospitals of Düsseldorf and Münster. 46 patients had nighttime sleep recorded for 6 months via smartwatch. Additionally, clinical scores (e.g., Inflammatory Rasch-built Overall Disability Scale), sleep (PSQI, Pittsburgh Sleep Quality Index), and quality of life (QoL) questionnaires were collected every 3 months. RESULTS: Of 46 participants, 40 met adherence criteria (≥ 75% wear time on ≥ 75% of nights, median age: 66 years [IQR: 59.5-70.3], 9 [22.5%] female). Median PSQI score was 6 (4-7.6), sleep efficiency 93% (92-95), and WASO (wake after sleep onset) 32 min (24-42). Smartwatch-derived objective sleep measures - sleep efficiency and WASO - correlated significantly with PSQI (Spearman's R = -0.49, R = 0.40), clinical scores, and QoL. INTERPRETATION: Sleep is impaired in patients with CIDP and contributes to the overall disease burden. Our findings suggest that sleep disturbances can be tracked longitudinally using smartwatch-derived markers. Integrating digital health data presents promising opportunities for long-term sleep monitoring in this population. Larger studies, ideally incorporating polysomnography, are warranted to validate these findings.
125Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study.PubMed
Asami Ito-Masui, Eiji Kawamoto, Ryota Sakamoto, et al.
JMIR Res Protoc. 2021 Mar 18;10(3):e24799. doi: 10.2196/24799.
BACKGROUND: Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy. OBJECTIVE: In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being. METHODS: This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared. RESULTS: Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021. CONCLUSIONS: iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24799.
126Feasibility of a Sleep Self-Management Intervention in Pregnancy Using a Personalized Health Monitoring Device: Protocol for a Pilot Randomized Controlled Trial.PubMed
Marquis Hawkins, Favorite Iradukunda, Mary Paterno
JMIR Res Protoc. 2019 May 29;8(5):e12455. doi: 10.2196/12455.
BACKGROUND: Sleep disruptions are common during pregnancy and associated with increased risk of adverse maternal outcomes such as preeclampsia, gestational diabetes, prolonged labor, and cesarean birth. Given the morbidity associated with poor sleep, cost-effective approaches to improving sleep that can be disseminated in community or clinical settings are needed. Personal health monitor (PHM) devices offer an opportunity to promote behavior change, but their acceptability and efficacy at improving sleep in pregnant women are unknown. OBJECTIVE: The goal of the paper is to describe the protocol for an ongoing pilot randomized controlled trial that aims to establish the feasibility, acceptability, and preliminary efficacy of using a PHM device (Shine 2, Misfit) to promote sleep during pregnancy. METHODS: The proposed pilot study is a 12-week, parallel arm, randomized controlled trial. Pregnant women, at 24 weeks gestation, will be randomized at a 1:1 ratio to a 12-week sleep education plus PHM device group or a sleep education alone comparison group. The primary outcomes will be measures of feasibility (ie, recruitment, enrollment, adherence) and acceptability (ie, participant satisfaction). The secondary outcomes will be self-reported sleep quality and duration, excessive daytime sleepiness, fatigue, and depressive symptoms. RESULTS: Recruitment for this study began in September 2017 and ended in March 2018. Data collection for the primary and secondary aims was completed in August 2018. We anticipate that the data analysis for primary and secondary aims will be completed by December 2019. The results from this trial will inform the development of a larger National Institutes of Health grant application to test the efficacy of an enhanced version of the sleep intervention that we plan to submit in the year 2020. CONCLUSIONS: This study will be the first to apply a PHM device as a tool for promoting self-management of sleep among pregnant women. PHM devices have the potential to facilitate behavioral interventions because they include theory-driven, self-regulatory techniques such as behavioral self-monitoring. The results of the study will inform the development of a sleep health intervention for pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov NCT03783663; https://clinicaltrials.gov/ct2/show/NCT03783663 (Archived by WebCite at http://www.webcitation.org/779Ou8hon). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12455.
127Does providing feedback and guidance on sleep perceptions using sleep wearables improve insomnia? Findings from "Novel Insomnia Treatment Experiment": a randomized controlled trial.PubMed
Marie-Antoinette Spina, Thomas Andrillon, Nina Quin, et al.
Sleep. 2023 Sep 8;46(9). doi: 10.1093/sleep/zsad167.
STUDY OBJECTIVES: Insomnia is a disorder diagnosed based on self-reported sleep complaints. Differences between self-reported and sensor-based sleep parameters (sleep-wake state discrepancy) are common but not well-understood in individuals with insomnia. This two-arm, parallel-group, single-blind, superiority randomized-controlled trial examined whether monitoring sleep using wearable devices and providing support for interpretation of sensor-based sleep data improved insomnia symptoms or impacted sleep-wake state discrepancy. METHODS: A total of 113 (age M = 47.53; SD = 14.37, 64.9% female) individuals with significant insomnia symptoms (Insomnia Severity Index(ISI) ≥10) from the community were randomized 1:1 (permuted block randomization) to receive 5 weeks (1) Intervention (n = 57): feedback about sensor-based sleep (Fitbit and EEG headband) with guidance for data interpretation and ongoing monitoring, and (2) Control (n = 56): sleep education and hygiene. Both groups received one individual session and two check-in calls. The ISI (primary outcome), sleep disturbance (SDis), sleep-related impairment (SRI), depression, and anxiety were assessed at baseline and post-intervention. RESULTS: In total, 103 (91.2%) participants completed the study. Intention-to-treat multiple regression with multiple imputations showed that after controlling for baseline values, compared to the Control group (n = 51), the Intervention group (n = 52) had lower ISI (p = .011, d = 0.51) and SDis (p = .036, d = 0.42) post-intervention, but differences in SRI, depression, anxiety, and sleep-wake state discrepancy parameters (total sleep time, sleep onset latency, and wake after sleep onset) were not meaningful (P-values >.40). CONCLUSIONS: Providing feedback and guidance about sensor-based sleep parameters reduced insomnia severity and sleep disturbance but did not alter sleep-wake state discrepancy in individuals with insomnia more than sleep hygiene and education. The role of sleep wearable devices among individuals with insomnia requires further research. CLINICAL TRIAL REGISTRATION: The Novel Insomnia Treatment Experiment (NITE): the effectiveness of incorporating appropriate guidance for sleep wearables in users with insomnia. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378452, Australia New Zealand Clinical Trials Registry: ACTRN12619001636145.
128Melatonin: Physiological effects in humans.PubMed
B Claustrat, J Leston
Neurochirurgie. 2015 Apr-Jun;61(2-3):77-84. doi: 10.1016/j.neuchi.2015.03.002. Epub 2015 Apr 20.
Melatonin is a methoxyindole synthesized and secreted principally by the pineal gland at night under normal light/dark conditions. The endogenous rhythm of secretion is generated by the suprachiasmatic nuclei and entrained to the light/dark cycle. Light is able to either suppress or synchronize melatonin production according to the light schedule. The nycthohemeral rhythm of this hormone can be evaluated by repeated measurement of plasma or saliva melatonin or urine sulfatoxymelatonin, the main hepatic metabolite. The primary physiological function of melatonin, whose secretion adjusts to night length, is to convey information concerning the daily cycle of light and darkness to body structures. This information is used for the organisation of functions, which respond to changes in the photoperiod such as the seasonal rhythms. Seasonal rhythmicity of physiological functions in humans related to possible alteration of the melatonin message remains, however, of limited evidence in temperate areas under field conditions. Also, the daily melatonin secretion, which is a very robust biochemical signal of night, can be used for the organisation of circadian rhythms. Although functions of this hormone in humans are mainly based on correlations between clinical observations and melatonin secretion, there is some evidence that melatonin stabilises and strengthens coupling of circadian rhythms, especially of core temperature and sleep-wake rhythms. The circadian organisation of other physiological functions depend also on the melatonin signal, for instance immune, antioxidant defences, haemostasis and glucose regulation. The difference between physiological and pharmacological effects of melatonin is not always clear but is based upon consideration of dose and not of duration of the hormone message. It is admitted that a "physiological" dose provides plasma melatonin levels in the same order of magnitude as a nocturnal peak. Since the regulating system of melatonin secretion is complex, following central and autonomic pathways, there are many pathophysiological situations where melatonin secretion can be disturbed. The resulting alteration could increase the predisposition to disease, add to the severity of symptoms or modify the course and outcome of the disorder. Since melatonin receptors display a very wide distribution in the body, putative therapeutic indications of this compound are multiple. Great advances in this field could be achieved by developing multicentre trials in a large series of patients, in order to establish efficacy of melatonin and absence of long-term toxicity.
129Melatonin: From Pharmacokinetics to Clinical Use in Autism Spectrum Disorder.PubMed
Sébastien Lalanne, Claire Fougerou-Leurent, George M Anderson, et al.
Int J Mol Sci. 2021 Feb 2;22(3):1490. doi: 10.3390/ijms22031490.
The role of melatonin has been extensively investigated in pathophysiological conditions, including autism spectrum disorder (ASD). Reduced melatonin secretion has been reported in ASD and led to many clinical trials using immediate-release and prolonged-release oral formulations of melatonin. However, melatonin's effects in ASD and the choice of formulation type require further study. Therapeutic benefits of melatonin on sleep disorders in ASD were observed, notably on sleep latency and sleep quality. Importantly, melatonin may also have a role in improving autistic behavioral impairments. The objective of this article is to review factors influencing treatment response and possible side effects following melatonin administration. It appears that the effects of exposure to exogenous melatonin are dependent on age, sex, route and time of administration, formulation type, dose, and association with several substances (such as tobacco or contraceptive pills). In addition, no major melatonin-related adverse effect was described in typical development and ASD. In conclusion, melatonin represents currently a well-validated and tolerated treatment for sleep disorders in children and adolescents with ASD. A more thorough consideration of factors influencing melatonin pharmacokinetics could illuminate the best use of melatonin in this population. Future studies are required in ASD to explore further dose-effect relationships of melatonin on sleep problems and autistic behavioral impairments.
130Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.PubMed
Michael J Sateia, Daniel J Buysse, Andrew D Krystal, et al.
J Clin Sleep Med. 2017 Feb 15;13(2):307-349. doi: 10.5664/jcsm.6470.
INTRODUCTION: The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad classes of drugs, this guideline focuses on individual drugs commonly used to treat insomnia. It includes drugs that are FDA-approved for the treatment of insomnia, as well as several drugs commonly used to treat insomnia without an FDA indication for this condition. This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults. METHODS: The American Academy of Sleep Medicine commissioned a task force of four experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, and patient values and preferences. Literature reviews are provided for those pharmacologic agents for which sufficient evidence was available to establish recommendations. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS: The following recommendations are intended as a guideline for clinicians in choosing a specific pharmacological agent for treatment of chronic insomnia in adults, when such treatment is indicated. Under GRADE, a STRONG recommendation is one that clinicians should, under most circumstances, follow. A WEAK recommendation reflects a lower degree of certainty in the outcome and appropriateness of the patient-care strategy for all patients, but should not be construed as an indication of ineffectiveness. GRADE recommendation strengths do not refer to the magnitude of treatment effects in a particular patient, but rather, to the strength of evidence in published data. Downgrading the quality of evidence for these treatments is predictable in GRADE, due to the funding source for most pharmacological clinical trials and the attendant risk of publication bias; the relatively small number of eligible trials for each individual agent; and the observed heterogeneity in the data. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. We suggest that clinicians use suvorexant as a treatment for sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use eszopiclone as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use zaleplon as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use zolpidem as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use triazolam as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use temazepam as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use ramelteon as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians use doxepin as a treatment for sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use tiagabine as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use diphenhydramine as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use melatonin as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use tryptophan as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK). We suggest that clinicians not use valerian as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK).
131Melatonin in Cancer Treatment: Current Knowledge and Future Opportunities.PubMed
Wamidh H Talib, Ahmad Riyad Alsayed, Alaa Abuawad, et al.
Molecules. 2021 Apr 25;26(9):2506. doi: 10.3390/molecules26092506.
Melatonin is a pleotropic molecule with numerous biological activities. Epidemiological and experimental studies have documented that melatonin could inhibit different types of cancer in vitro and in vivo. Results showed the involvement of melatonin in different anticancer mechanisms including apoptosis induction, cell proliferation inhibition, reduction in tumor growth and metastases, reduction in the side effects associated with chemotherapy and radiotherapy, decreasing drug resistance in cancer therapy, and augmentation of the therapeutic effects of conventional anticancer therapies. Clinical trials revealed that melatonin is an effective adjuvant drug to all conventional therapies. This review summarized melatonin biosynthesis, availability from natural sources, metabolism, bioavailability, anticancer mechanisms of melatonin, its use in clinical trials, and pharmaceutical formulation. Studies discussed in this review will provide a solid foundation for researchers and physicians to design and develop new therapies to treat and prevent cancer using melatonin.
132Melatonin protects mouse testes from palmitic acid-induced lipotoxicity by attenuating oxidative stress and DNA damage in a SIRT1-dependent manner.PubMed
Dejun Xu, Lingbin Liu, Yongju Zhao, et al.
J Pineal Res. 2020 Nov;69(4):e12690. doi: 10.1111/jpi.12690. Epub 2020 Sep 4.
Palmitic acid (PA), the main component of dietary saturated fat, has been known to increase in patients with obesity, and PA-induced lipotoxicity may contribute to obesity-related male infertility. Melatonin has beneficial effects on reproductive processes; however, the effect and the underlying molecular mechanism of melatonin's involvement in PA-induced cytotoxicity in the testes are poorly understood. Our findings showed that lipotoxicity was observed in mouse testes after long-term PA treatment and that melatonin therapy restored spermatogenesis and fertility in these males. Moreover, melatonin therapy suppressed PA-induced apoptosis by modulating apoptosis-associated proteins such as Bcl2, Bax, C-Caspase3, C-Caspase12, and CHOP in type B spermatogonial stem cells. Changes in the expression of endoplasmic reticulum (ER) stress markers (p-IRE1, p-PERK, ATF4) and intracellular Ca levels showed that melatonin relieved PA-induced ER stress. Mechanistically, melatonin stimulated the expression and nuclear translocation of SIRT1 through its receptors and prevented PA-induced ROS production and mitochondrial dysfunction via SIRT1 signaling pathway. Furthermore, melatonin promoted SIRT1-mediated p53 deacetylation, thereby relieving G2/M arrest in response to PA-stimulated DNA damage. Collectively, these findings indicate that melatonin protects the testes from PA-induced lipotoxicity through the activation of SIRT1, which alleviates oxidative stress, ER stress, mitochondrial dysfunction, and DNA damage.
133Vascular wall microenvironment: Endothelial cells original exosomes mediated melatonin-suppressed vascular calcification and vascular ageing in a m6A methylation dependent manner.PubMed
Su-Kang Shan, Xiao Lin, Feng Wu, et al.
Bioact Mater. 2024 Aug 28;42:52-67. doi: 10.1016/j.bioactmat.2024.08.021. eCollection 2024 Dec.
Vascular calcification and vascular ageing are "silent" diseases but are highly prevalent in patients with end stage renal failure and type 2 diabetes, as well as in the ageing population. Melatonin (MT) has been shown to induce cardiovascular protection effects. However, the role of MT on vascular calcification and ageing has not been well-identified. In this study, the aortic transcriptional landscape revealed clues for MT related cell-to-cell communication between endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) in vascular calcification and vascular ageing. Furthermore, we elucidated that it was exosomes that participate in the information transportation from ECs to VSMCs. The exosomes secreted from melatonin-treated ECs (MT-ECs-Exos) inhibited calcification and senescence of VSMCs. Mechanistically, miR-302d-5p was highly enriched in MT-ECs-Exos, while depletion of miR-302d-5p blocked the ability of MT-ECs-Exos to suppress VSMC calcification and senescence. Notably, Wnt3 was a bona fide target of miR-302d-5p and modulated VSMC calcification and senescence. Furthermore, we found that maturation of endothelial derived exosomal miR-302d-5p was promoted by WTAP in an N-methyladenosine (mA)-dependent manner. Interestingly, MT alleviated vascular calcification and ageing in 5/6-nephrectomy (5/6 NTP) mice, a chronic kidney disease (CKD) induced vascular calcification and vascular ageing mouse model. MT-ECs-Exos was absorbed by VSMCs in vivo and effectively prevented vascular calcification and ageing in 5/6 NTP mice. ECs-derived miR-302d-5p mediated MT induced anti-calcification and anti-ageing effects in 5/6 NTP mice. Our study suggests that MT-ECs-Exos alleviate vascular calcification and ageing through the miR-302d-5p/Wnt3 signaling pathway, dependent on mA methylation.
134Melatonin alleviates doxorubicin-induced cardiotoxicity via inhibiting oxidative stress, pyroptosis and apoptosis by activating Sirt1/Nrf2 pathway.PubMed
Wei Zhang, Xi Wang, Yanhong Tang, et al.
Biomed Pharmacother. 2023 Jun;162:114591. doi: 10.1016/j.biopha.2023.114591. Epub 2023 Mar 23.
Melatonin confers cardioprotective effects on multiple cardiovascular diseases, including doxorubicin-induced cardiomyopathy. The effectiveness of melatonin in mitigating myocardial injuries caused by Doxorubicin through enhancement of mitochondrial function is already established, however, the role of melatonin in regulating the Sirtuin-1 (Sirt1)/Nuclear factor E2-associated factor 2 (Nrf2) pathway in lessening the onset of Doxorubicin-induced cardiomyopathy is yet to be elucidated. To address this, H9C2 cardiomyocytes and C57BL/6 mice were employed to construct in vitro and in vivo models of Dox-induced myocardial impairments, respectively. Results showed that Dox markedly evoked oxidative stress, pyroptosis and apoptosis both in vitro and in vivo, which were significantly alleviated by melatonin administration. Mechanistically, melatonin attenuated Dox-induced downregulation of Sirt1 and Nrf2, and both inhibition of Sirt1 and Nrf2 significantly reversed the cardioprotective effects of melatonin. In conclusion, our studies suggest that the activation of the Sirt1/Nrf2 pathway is the underlying mechanism behind melatonin's ability to curtail oxidative stress, pyroptosis, and apoptosis in Dox-induced cardiomyopathy. These promising results demonstrated the potential application of melatonin as a treatment for doxorubicin-induced cardiac injury.
135Melatonin mitigates aflatoxin B1-induced liver injury via modulation of gut microbiota/intestinal FXR/liver TLR4 signaling axis in mice.PubMed
Shuiping Liu, Weili Kang, Xinru Mao, et al.
J Pineal Res. 2022 Sep;73(2):e12812. doi: 10.1111/jpi.12812. Epub 2022 Jun 12.
Aflatoxin B1 (AFB1) is a widespread contaminant in foods and feedstuffs, and its target organ is the liver. Melatonin (MT) has been shown to alleviate inflammation in organs and remodel gut microbiota in animals and humans. However, the underlying mechanism by which MT alleviates AFB1-induced liver injury remains unclear. In the present study, MT pretreatment markedly increased the expression of intestinal tight junction proteins (ZO-1, Occludin, and Claudin-1), decreased intestinal permeability, reduced production of gut-derived Lipopolysaccharide (LPS) and remodeled gut microbiota, ultimately alleviated AFB1-induced liver injury in mice. Interestingly, MT pretreatment failed to exert beneficial effects on the intestine and liver in antibiotic-treated mice. Meanwhile, MT pretreatment significantly increased the farnesoid X receptor (FXR) protein expression of ileum, and decreased the TLR4/NF-κB signaling pathway-related messenger RNA (mRNA) and proteins (TLR4, MyD88, p-p65, and p-IκBα) expression in livers of AFB1-exposed mice. Subsequently, pretreatment by Gly-β-MCA, an intestine-selective FXR inhibitor, blocked the alleviating effect of MT on liver injury through increasing the liver-specific expression of TLR4/NF-κB signaling pathway-related mRNA and proteins (TLR4, MyD88, p-p65, and p-IκBα). In conclusion, MT pretreatment ameliorated AFB1-induced liver injury and the potential mechanism may be related to regulate gut microbiota/intestinal FXR/liver TLR4 signaling axis, which provides a strong evidence for the protection of gut-derived liver inflammation.
136Effects of magnesium and potassium supplementation on insomnia and sleep hormones in patients with diabetes mellitus.PubMed
Sidra Khalid, Shahid Bashir, Riffat Mehboob, et al.
Front Endocrinol (Lausanne). 2024 Oct 29;15:1370733. doi: 10.3389/fendo.2024.1370733. eCollection 2024.
OBJECTIVES: Diabetes mellitus is a metabolic condition with hyperglycemia. Literature has shown a correlation between poor sleep quality and duration with an increased incidence of insomnia in diabetic individuals. The goal of this study was to determine the magnesium and potassium supplementation effect among diabetic individuals with insomnia. METHODS: A randomized controlled trial (single blind) was conducted on 320 patients with diabetes; after 2 months of follow-up, 290 patients completed the trial. The Insomnia Severity Index (ISI) was used to assess the severity and duration of insomnia, before and after the trial. Tablets containing supplements were prepared: placebo (T1), magnesium (Mg, T2), potassium (K, T3), and a combination of Mg and K (T4). Melatonin and cortisol (sleep hormones) were measured from blood (serum) using an enzyme-linked immunosorbent assay (ELISA), before and after the trial. RESULTS: The study included 93 (32.1%) male and 197 (67.9%) female participants. According to the analysis, there was a significant association between the treatment groups and ISI after the trial (post-trial), = 0.0001. Analysis showed that there was significant association between pre- and post-serum cortisol levels in treatment groups 2, 3, and 4 (T2, T3, and T4) as -values are 0.001, 0.001, and 0.001 respectively. Similar findings were observed for serum melatonin. CONCLUSIONS: The study revealed that magnesium, potassium, and magnesium and potassium combined had a significant effect on serum cortisol and melatonin levels (sleep hormones). In addition, supplementation significantly decreased the severity of insomnia among patients with diabetes by improving sleep duration.
137Melatonin attenuates diabetic cardiomyopathy by increasing autophagy of cardiomyocytes via regulation of VEGF-B/GRP78/PERK signaling pathway.PubMed
Shengzheng Zhang, Wencong Tian, Xianxian Duan, et al.
Cardiovasc Diabetol. 2024 Jan 9;23(1):19. doi: 10.1186/s12933-023-02078-x.
AIMS: Diabetic cardiomyopathy (DCM) is a major cause of mortality in patients with diabetes, and the potential strategies for treating DCM are insufficient. Melatonin (Mel) has been shown to attenuate DCM, however, the underlying mechanism remains unclear. The role of vascular endothelial growth factor-B (VEGF-B) in DCM is little known. In present study, we aimed to investigate whether Mel alleviated DCM via regulation of VEGF-B and explored its underlying mechanisms. METHODS AND RESULTS: We found that Mel significantly alleviated cardiac dysfunction and improved autophagy of cardiomyocytes in type 1 diabetes mellitus (T1DM) induced cardiomyopathy mice. VEGF-B was highly expressed in DCM mice in comparison with normal mice, and its expression was markedly reduced after Mel treatment. Mel treatment diminished the interaction of VEGF-B and Glucose-regulated protein 78 (GRP78) and reduced the interaction of GRP78 and protein kinase RNA -like ER kinase (PERK). Furthermore, Mel increased phosphorylation of PERK and eIF2α, then up-regulated the expression of ATF4. VEGF-B mice imitated the effect of Mel on wild type diabetic mice. Interestingly, injection with Recombinant adeno-associated virus serotype 9 (AAV9)-VEGF-B or administration of GSK2656157 (GSK), an inhibitor of phosphorylated PERK abolished the protective effect of Mel on DCM. Furthermore, rapamycin, an autophagy agonist displayed similar effect with Mel treatment; while 3-Methyladenine (3-MA), an autophagy inhibitor neutralized the effect of Mel on high glucose-treated neonatal rat ventricular myocytes. CONCLUSIONS: These results demonstrated that Mel attenuated DCM via increasing autophagy of cardiomyocytes, and this cardio-protective effect of Mel was dependent on VEGF-B/GRP78/PERK signaling pathway.
138Diabetes mellitus and melatonin: Where are we?PubMed
Roma Patel, Nishant Parmar, Sayantani Pramanik Palit, et al.
Biochimie. 2022 Nov;202:2-14. doi: 10.1016/j.biochi.2022.01.001. Epub 2022 Jan 7.
Diabetes mellitus (DM) and diabetes-related complications are amongst the leading causes of mortality worldwide. The international diabetes federation (IDF) has estimated 592 million people to suffer from DM by 2035. Hence, finding a novel biomolecule that can effectively aid diabetes management is vital, as other existing drugs have numerous side effects. Melatonin, a pineal hormone having antioxidative and anti-inflammatory properties, has been implicated in circadian dysrhythmia-linked DM. Reduced levels of melatonin and a functional link between melatonin and insulin are implicated in the pathogenesis of type 2 diabetes (T2D). Additionally, genomic studies revealed that rare variants in melatonin receptor 1b (MTNR1B) are also associated with impaired glucose tolerance and increased risk of T2D. Moreover, exogenous melatonin treatment in cell lines, rodent models, and diabetic patients has shown a potent effect in alleviating diabetes and other related complications. This highlights the role of melatonin in glucose homeostasis. However, there are also contradictory reports on the effects of melatonin supplementation. Thus, it is essential to explore if melatonin can be taken from bench to bedside for diabetes management. This review summarizes the therapeutic potential of melatonin in various diabetic models and whether it can be considered a safe drug for managing diabetic complications and diabetic manifestations like oxidative stress, inflammation, ER stress, mitochondrial dysfunction, metabolic dysregulation, etc.
139Effect of mirtazapine orally disintegrating tablets on health-related quality of life in elderly depressed patients with comorbid medical disorders: a pilot study.PubMed
Indira Varia, Srimathi Venkataraman, Caroline Hellegers, et al.
Psychopharmacol Bull. 2007;40(1):47-56.
BACKGROUND: There is a need for additional studies on the quality of life (QOL) of elderly depressed subjects with medical comorbidity. METHOD: We conducted a 10-week, open trial of mirtazapine orally disintegrating tablets in 16 elderly subjects with major depressive disorder and one or more serious medical illnesses. Quality of life was measured by the Medical Outcomes Study Short Form-36 Health Status Survey (SF- 36). RESULTS: Treatment with mirtazapine was associated with significant reductions in clinical global impressions-severity of illness scale (CGI-S) score, the Hamilton rating scale for anxiety (HAM-A) total score, the 17-item Hamilton rating scale for depression (HAM-D) total score and the Beck depression inventory (BDI) total scores. The SF-36 "physical functioning", "role limitation physical", "vitality", "social functioning", "role limitation emotional", and "mental health" domains improved significantly. The mean mirtazapine dose at endpoint was 35 mg per day. The drug was relatively well tolerated except for three subjects who dropped out because of side effects. No drug-drug interactions or significant changes in blood pressure or heart rate occurred. CONCLUSION: Mirtazapine orally disintegrating tablets may improve depression, insomnia, anxiety, somatic symptoms, and certain quality-of-life measures in elderly depressed subjects with medical disorders. A randomized, placebo-controlled study is warranted to confirm these promising findings.
140Case series of perimenopausal women with insomnia treated with mirtazapine followed by prolonged-release melatonin add-on and monotherapy.PubMed
Zipora Dolev
Arch Womens Ment Health. 2011 Jun;14(3):269-73. doi: 10.1007/s00737-011-0205-7. Epub 2011 Feb 12.
OBJECTIVES: The sedating antidepressant mirtazapine is used off label for insomnia in perimenopausal women. Despite its apparent efficacy, mirtazapine causes significant increases in appetite and weight gain. Prolonged-release melatonin (PRM) is approved for primary insomnia in patients aged 55 years and older. A clinical experience with PRM add-on to mirtazapine in facilitating mirtazapine withdrawal while maintaining improved sleep quality and abrogating weight gain in perimenopausal women with insomnia is described. METHODS: Eleven perimenopausal women (ages 45-52; FSH = 53 ± 8; normal BMI, 22.9 ± 0.6) with insomnia, who do not suffer from depression as assessed by the Hamilton scale, were treated with 15 mg mirtazapine (Remeron®) for 2-4 weeks. PRM, 2 mg (Circadin®), was then added on, and mirtazapine was tapered off for another 1-3 months. Prospective data on body weight and subjectively assessed sleep quality and well-being (assessed by the Pittsburgh Sleep Quality Index, PSQI, and Well-Being Index, WHO-5, respectively) were collected before, during, and at the end of the treatment. RESULTS: Sleep quality ratings improved significantly (by 103% on average) during combined mirtazapine and PRM intake and 180% during subsequent intake of PRM alone or together with very low doses of mirtazapine (P < 0.05 for all). Well-being significantly improved by 83% during the treatment. Seven of 11 women demonstrated weight gain following mirtazapine intake, five of whom have started to reduce weight following mirtazapine withdrawal and PRM intake. No adverse events were reported. CONCLUSION: Application of mirtazapine followed by PRM add-on and monotherapy improves sleep in perimenopausal women while evading mirtazapine-induced weight gain. These results warrant further investigation of a larger population in controlled clinical trials.
141Long-Term Use of Benzodiazepines and Nonbenzodiazepine Hypnotics, 1999-2014.PubMed
Christopher N Kaufmann, Adam P Spira, Colin A Depp, et al.
Psychiatr Serv. 2018 Feb 1;69(2):235-238. doi: 10.1176/appi.ps.201700095. Epub 2017 Nov 1.
OBJECTIVE: Clinical guidelines suggest that benzodiazepines (BZDs) and non-BZD hypnotics (NBHs) be used on a short-term basis. The authors examined trends in long-term BZD and NBH use from 1999 to 2014. METHODS: Data included 82,091 respondents in the 1999-2014 waves of the National Health and Nutrition Examination Survey (NHANES). NHANES recorded medications used in the past 30 days on the basis of prescription bottles, and participants reported use duration. BZD and NBH use were categorized as short, medium, and long term, and time trends in use were assessed. RESULTS: BZD and NBH use increased from 1999 to 2014, driven by increases in medium- and long-term use, even after adjustment for age and race-ethnicity. In most years, only a fifth of current BZD or NBH users reported short-term use. CONCLUSIONS: Long-term BZD and NBH use has grown independent of U.S. demographic shifts. Monitoring of use is needed to prevent adverse outcomes.
142The Comparative Effectiveness and Safety of Insomnia Drugs: A Systematic Review and Network Meta-Analysis of 153 Randomized Trials.PubMed
Bei Pan, Long Ge, Honghao Lai, et al.
Drugs. 2023 May;83(7):587-619. doi: 10.1007/s40265-023-01859-8. Epub 2023 Mar 22.
BACKGROUND: Pharmacological treatment is common in practice and widely used for the management of insomnia. However, evidence comparing the relative effectiveness, safety, and certainty of evidence among drug classes and individual drugs for insomnia are still lacking. This study aimed to determine the relative effectiveness, safety, and tolerability of drugs for insomnia. METHODS: In this systematic review and network meta-analysis we systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and ClinicalTrials.gov, from inception to January 10, 2022 to identify randomized controlled trials that compared insomnia drugs with placebo or an active comparator in adults with insomnia. We conducted random-effects frequentist network meta-analyses to summarize the evidence, and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty, categorize interventionsand present the findings. RESULTS: A total of 148 articles met our eligibility criteria; these included 153 trials which enrolled 46,412 participants and assessed 36 individual drugs from eight drug classes. Compared with placebo, both subjectively and objectively measured total sleep time were significantly improved with non-benzodiazepine (subjective: mean difference [MD] 25.07, 95% confidence interval [CI] 15.49-34.64, low certainty; objective: MD 22.34, 95% CI 7.64-37.05, high certainty), antidepressants (subjective: MD 54.40, 95% CI 34.96-75.83, low certainty; objective: MD 35.64, 95% CI 13.05-58.24, high certainty), and orexin receptor antagonists (subjective: MD 21.62, 95% CI 0.84-42.40, high certainty; objective: MD 31.81, 95% CI 2.66-60.95, high certainty); of which doxepin, almorexant, suvorexant, and lemborexant were among the relatively effective drugs with relatively good tolerability and lower risks of any adverse events (AEs). Both subjectively and objectively measured sleep onset latency were significantly shortened with non-benzodiazepines (subjective: MD - 10.12, 95% CI - 13.84 to - 6.40, moderate certainty; objective: MD - 12.11, 95% CI - 19.31 to - 4.90, moderate certainty) and melatonin receptor agonists (subjective: MD - 7.73, 95% CI - 15.21 to - 0.26, high certainty; objective: MD - 7.04, 95% CI - 12.12 to - 1.95, moderate certainty); in particular, zopiclone was among the most effective drugs with a lower risk of any AEs but worse tolerability. Non-benzodiazepines could significantly decrease both subjective and objective measured wake time after sleep onset (subjective: MD - 16.67, 95% CI - 21.79 to - 11.56, moderate certainty; objective: MD - 13.92, 95% CI - 22.71 to - 5.14, moderate certainty). CONCLUSIONS: Non-benzodiazepines probably improve total sleep time, sleep onset latency, and wake time after sleep onset. Other insomnia drug classes and individual drugs also showed potential benefits in improving insomnia symptoms. However, the choice of insomnia drugs should be based on the phenotype of insomnia presented, as well as each drug's safety and tolerability. Protocol registration PROSPERO (CRD42019138790).
143Incidence and Predictors of Long-Term Hypnotic Receipt among Patients with Chronic Obstructive Pulmonary Disease.PubMed
Jason M Castaneda, Aristotle Leonhard, Laura J Spece, et al.
Ann Am Thorac Soc. 2025 Jun;22(6):863-871. doi: 10.1513/AnnalsATS.202407-798OC.
Many patients with chronic obstructive pulmonary disease (COPD) receive hypnotic prescriptions to mitigate insomnia symptoms. Although clinical practice guidelines advise short-term use, patients often receive these medications on a long-term basis. Because patients with COPD may be more susceptible to adverse effects of hypnotic medication, it is critical that we better understand the incidence and potential influences of this practice. To characterize the incidence and predictors of guideline-discordant long-term receipt of hypnotic medications among patients with COPD. Using nationwide Veterans Health Administration data, we identified patients with clinically diagnosed COPD from 2010 to 2019 without prior hypnotic medication receipt in the previous 1 year. To identify individuals with new hypnotic agent use, we restricted this sample to those who received at least 30 total days of zolpidem, melatonin, trazodone, and/or doxepin within a 90-day period. We defined long-term hypnotic medication receipt as continued availability of one of these hypnotic medications for ≥30 days within the subsequent 90-day period. We then used a mixed-effects logistic regression model to assess patient and site-level associations with long-term receipt. Among 4,262 patients with COPD and new hypnotic medication receipt, 55.6% ( = 2,371) continued to receive hypnotic medications on a long-term basis. Long-term receipt was positively associated with short-acting β-agonist receipt (for every 10% increase in days with short-acting β-agonist availability, odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05), maintenance inhaler prescriptions (monotherapy, OR, 1.35; 95% CI, 1.10-1.68; dual therapy, OR, 1.43; 95% CI, 1.20-1.70; triple therapy, OR, 1.54; 95% CI, 1.24-1.91), posttraumatic stress disorder (OR, 1.21; 95% CI, 1.02-1.44), major depressive disorder (OR, 1.24; 95% CI, 1.07-1.44), anxiety disorder (OR, 1.21; 95% CI, 1.03-1.44), and more frequent primary care visits (more than five visits in the past 12 mo, OR, 1.86; 95% CI, 1.19-2.90). Long-term receipt was negatively associated with initial receipt of melatonin (OR, 0.70; 95% CI, 0.55-0.91) and more than one pulmonary visit in the previous 12 months (OR, 0.74; 95% CI, 0.56-0.97). Despite guideline recommendations, long-term hypnotic medication receipt is common among patients with COPD. Future work to prevent long-term hypnotic prescriptions should consider the role that respiratory symptoms and mental health comorbidities may have in driving this practice.
144Benzodiazepine harm: how can it be reduced?PubMed
Malcolm Lader
Br J Clin Pharmacol. 2014 Feb;77(2):295-301. doi: 10.1111/j.1365-2125.2012.04418.x.
The benzodiazepines (BZDs) are anxiolytics, hypnotics, anticonvulsants, muscle-relaxants and induce anaesthesia. Adverse effects comprise sedation subjectively and cognitive and psychomotor impairment objectively. Complex skills such as driving can be compromised. Paradoxical excitement can have forensic implications. Long term use beyond the licensed durations is common but both efficacy and adverse effects associated with this have been poorly documented. Withdrawal and dependence have excited particular concern, and even polemic. Perhaps a third of long term (beyond 6 months) users experience symptoms and signs on attempting to withdraw - anxiety, insomnia, muscle spasms and tension and perceptual hypersensitivity. Uncommonly, fits or a psychosis may supervene. The patterns following withdrawal vary widely. The usual method of withdrawal is slow tapering but it may not obviate the problems completely. BZDs are also drugs of abuse either on their own or in conjunction with opioids and stimulants. Claims have been made that the use of BZDs is associated with increased mortality. This is a concern in view of the widespread usage of these drugs, particularly in the elderly. All of these factors impinge on the risk : benefit ratio and the severity of the indications. Harm reduction should focus on choice of alternative treatments both psychological and pharmacological. Guidelines emphasise that BZDs are not drugs of first choice and should only be used short term. Schedules are available to educate about methods of withdrawal in current users, emphasising the slow rate of taper. General principles of harm minimization in the addiction field are appropriate to BZD abuse.
145Benzodiazepines revisited--will we ever learn?PubMed
Malcolm Lader
Addiction. 2011 Dec;106(12):2086-109. doi: 10.1111/j.1360-0443.2011.03563.x. Epub 2011 Oct 17.
AIMS: To re-examine various aspects of the benzodiazepines (BZDs), widely prescribed for 50 years, mainly to treat anxiety and insomnia. It is a descriptive review based on the Okey Lecture delivered at the Institute of Psychiatry, King's College London, in November 2010. METHODS: A search of the literature was carried out in the Medline, Embase and Cochrane Collaboration databases, using the codeword 'benzodiazepine(s)', alone and in conjunction with various terms such as 'dependence', 'abuse', etc. Further hand-searches were made based on the reference lists of key papers. As 60,000 references were found, this review is not exhaustive. It concentrates on the adverse effects, dependence and abuse. RESULTS: Almost from their introduction the BZDs have been controversial, with polarized opinions, advocates pointing out their efficacy, tolerability and patient acceptability, opponents deprecating their adverse effects, dependence and abuse liability. More recently, the advent of alternative and usually safer medications has opened up the debate. The review noted a series of adverse effects that continued to cause concern, such as cognitive and psychomotor impairment. In addition, dependence and abuse remain as serious problems. Despite warnings and guidelines, usage of these drugs remains at a high level. The limitations in their use both as choice of therapy and with respect to conservative dosage and duration of use are highlighted. The distinction between low-dose 'iatrogenic' dependence and high-dose abuse/misuse is emphasized. CONCLUSIONS: The practical problems with the benzodiazepines have persisted for 50 years, but have been ignored by many practitioners and almost all official bodies. The risk-benefit ratio of the benzodiazepines remains positive in most patients in the short term (2-4 weeks) but is unestablished beyond that time, due mainly to the difficulty in preventing short-term use from extending indefinitely with the risk of dependence. Other research issues include the possibility of long-term brain changes and evaluating the role of the benzodiazepine antagonist, flumazenil, in aiding withdrawal.
146Comparative efficacy of lemborexant and other insomnia treatments: a network meta-analysis.PubMed
Heather McElroy, Beth O'Leary, Michael Adena, et al.
J Manag Care Spec Pharm. 2021 Sep;27(9):1296-1308. doi: 10.18553/jmcp.2021.21011. Epub 2021 Jun 12.
Insomnia is a common disorder associated with a substantial burden of illness, particularly in older adults. To compare the efficacy and safety of lemborexant with specified other insomnia treatments through a systematic literature review and network meta-analysis (NMA). Medline and Embase were systematically searched from inception to February 2019 and updated with a targeted search of PubMed for pivotal trials in March 2021. Randomized controlled trials in adults with primary insomnia were included if they reported results following at least 1 week of treatment. Interventions of interest were specified as lemborexant, suvorexant, benzodiazepines, benzodiazepine receptor agonists (also called Z-drugs [zolpidem, eszopiclone, zaleplon, zopiclone]), trazodone, and ramelteon. Efficacy outcomes included wake after sleep onset (WASO), sleep efficiency (SE), latency to persistent sleep (LPS)/sleep onset latency (SOL), total sleep time (TST) and Insomnia Severity Index (ISI). Bayesian NMA were performed at predetermined time intervals approximating 4 weeks, 3 months, and 6 months. Safety outcomes included serious adverse events (SAEs), withdrawals due to adverse events (AEs), and specified AEs (dizziness, somnolence, and falls). Subgroup analysis was conducted in the older population. 45 studies were included in the NMA. At 4 weeks, lemborexant had the highest probability of being the best treatment for 3 of the 4 outcomes measured objectively by polysomnography-TST, LPS, and SE-and was ranked second to suvorexant on WASO. Eszopiclone was highly ranked for subjectively measured SOL and ISI at 4 weeks, 3 months, and 6 months. Lemborexant was rated more highly than suvorexant in subjective measures of WASO, TST, and SOL at 4 weeks (the differences were not statistically significant). No statistically significant interactions between treatment effect and older subpopulations were found, indicating that the treatment effect was similar in older and adult populations. The safety profile of lemborexant was broadly similar to the other treatments for SAEs and withdrawals due to AEs. A limitation is the age of some of the included studies (3 were published in 1990 or earlier). A further limitation is the lack of stratification of recommended doses. If the doses used in the study publications do not reflect doses used in clinical practice, this could potentially bias the results. Lemborexant was ranked highest of the treatments studied on 3 out of the 4 objectively measured insomnia efficacy outcomes, with a safety profile broadly similar to other insomnia treatments. This work was funded by Eisai Inc., which was involved with all stages of the study and analysis. McElroy, O'Leary, and Adena are consultants with Datalytics Pty Ltd., which was paid by Eisai Inc. for conducting the literature review and analysis. They were not financially compensated for collaborative efforts on publication-related activities. Campbell, Tahami Monfared, and Meier are employed by Eisai Inc. This study was presented as a poster at AMCP Nexus Virtual, October 20-23, 2020 and at the AGS Virtual Annual Scientific Meeting 2021, May 13-15, 2021.
147Effects of Tai Chi or Exercise on Sleep in Older Adults With Insomnia: A Randomized Clinical Trial.PubMed
Parco M Siu, Angus P Yu, Bjorn T Tam, et al.
JAMA Netw Open. 2021 Feb 1;4(2):e2037199. doi: 10.1001/jamanetworkopen.2020.37199.
IMPORTANCE: Previous studies that have shown tai chi to improve sleep were mainly based on subjective assessments, which might have produced results confounded by self-reporting bias. OBJECTIVE: To compare the effectiveness of tai chi for improving sleep in older adults with insomnia with conventional exercise and a passive control group using actigraphy-based objective measurements. DESIGN, SETTING, AND PARTICIPANTS: This randomized, 3-arm, parallel group, assessor-masked clinical trial was conducted at a single research unit in Hong Kong between August 2014 and August 2018. Eligible participants, aged 60 years or older and with chronic insomnia, were randomly allocated into tai chi training, exercise, and control groups. INTERVENTIONS: 12-week tai chi training, 12-week conventional exercise, and no intervention control. MAIN OUTCOMES AND MEASURES: Primary outcomes were measures taken from actigraphy sleep assessment. Secondary outcomes included remission of insomnia, insomnia treatment response, Pittsburgh Sleep Quality Index score, Insomnia Severity Index score, and self-reported sleep using a 7-day sleep diary. Assessments were performed at baseline, end of the intervention (postintervention), and 24 months after the intervention (follow-up). Data analysis was performed from September 2018 to August 2020. RESULTS: A total of 320 participants (mean [SD] age, 67.3 [6.8] years; mean [SD] insomnia duration, 124.4 [134.5] months; 256 [80.0%] women) were randomly allocated into control (110 participants), exercise (105 participants), and tai chi (105 participants) groups and included in the data analysis. Compared with the control group, the exercise and tai chi groups showed improved sleep efficiency (exercise vs control: adjusted mean difference, +3.5%; 95% CI, 1.8-5.2; P < .001; tai chi vs control: adjusted mean difference, +3.4%; 95% CI, 1.6-5.1; P < .001) and reductions of wake time after sleep onset (exercise vs control: -17.0 minutes; 95% CI, -24.9 to -9.0; P < .001; tai chi vs control: -13.3 minutes; 95% CI, -21.3 to -5.2; P = .001) and number of awakenings (exercise vs control: -2.8 times; 95% CI, -4.0 to -1.6; P < .001; tai chi vs control: -2.2 times; 95% CI, -3.5 to -1.0; P < .001) as assessed by actigraphy at postintervention; although there were no significant differences between the exercise and tai chi groups. The actigraphy-assessed beneficial effects were maintained in both intervention groups at follow-up. CONCLUSIONS AND RELEVANCE: Conventional exercise and tai chi improved sleep and the beneficial effects sustained for 24 months, although the absolute improvements in sleep parameters were modest. Improvements in objective sleep parameters were not different between the tai chi and exercise groups, suggesting that tai chi can be an alternative approach for managing insomnia. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02260843.
148Effect of simplified Tai Chi exercise on relieving symptoms of patients with mild to moderate Parkinson's disease.PubMed
Mingjin Zhu, Yonghua Zhang, Jiafei Pan, et al.
J Sports Med Phys Fitness. 2020 Feb;60(2):282-288. doi: 10.23736/S0022-4707.19.10104-1. Epub 2019 Oct 25.
BACKGROUND: Tai Chi, a kind of physical exercise, may act as a non-pharmacologic approach to reducing the symptoms of Parkinson's disease. This study was conducted to investigate the effect of simplified Tai Chi training plus routine exercise on motor and non-motor symptoms in patients with mild to moderate Parkinson's disease in comparison with routine exercise regimen alone. METHODS: Forty-one outpatients and inpatients with Parkinson's disease (PD) were randomized into Tai Chi group (N.=19) and routine exercise group as control group (N.=22) for 12 weeks. The Tai Chi group included both Tai Chi traning and routine exercise. Motor and non-motor functions were assessed. Motor function was evaluated by Unified Parkinson's Disease Rating Scale part III (UPDRS-III) and Berg Balance Scale (BBS). The non-motor symptoms like quality of life, sleep quality, depression and anxiety state, cognitive function were assessed by Parkinson's Disease Questionnaire-39 (PDQ-39), Parkinson's Disease Sleep Scale (PDSS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Montreal Cognitive Assessment (MOCA) respectively. RESULTS: After 12 weeks of intervention, participants in both Tai Chi and routine exercise groups gained effects in UPDRS-III, BBS, PDQ-39, PDSS and HAMD compared to the baseline. However, significant improvements between Tai Chi group and routine exercise group were only found in PDSS (P=0.029) and MoCA (P=0.024). CONCLUSIONS: Tai Chi training plus routine exercise might therefore be an ideal alternative non-pharmacological approach for the motor and non-motor symptoms of PD patients, and especially be more useful for the improvement of sleep quality and cognitive function in Parkinson's disease compared with routine exercise regimen alone.
149Tai Chi increases functional connectivity and decreases chronic fatigue syndrome: A pilot intervention study with machine learning and fMRI analysis.PubMed
Kang Wu, Yuanyuan Li, Yihuai Zou, et al.
PLoS One. 2022 Dec 1;17(12):e0278415. doi: 10.1371/journal.pone.0278415. eCollection 2022.
BACKGROUND: The latest guidance on chronic fatigue syndrome (CFS) recommends exercise therapy. Tai Chi, an exercise method in traditional Chinese medicine, is reportedly helpful for CFS. However, the mechanism remains unclear. The present longitudinal study aimed to detect the influence of Tai Chi on functional brain connectivity in CFS. METHODS: The study recruited 20 CFS patients and 20 healthy controls to receive eight sessions of Tai Chi exercise over a period of one month. Before the Tai Chi exercise, an abnormal functional brain connectivity for recognizing CFS was generated by a linear support vector model. The prediction ability of the structure was validated with a random forest classification under a permutation test. Then, the functional connections (FCs) of the structure were analyzed in the large-scale brain network after Tai Chi exercise while taking the changes in the Fatigue Scale-14, Pittsburgh Sleep Quality Index (PSQI), and the 36-item short-form health survey (SF-36) as clinical effectiveness evaluation. The registration number is ChiCTR2000032577 in the Chinese Clinical Trial Registry. RESULTS: 1) The score of the Fatigue Scale-14 decreased significantly in the CFS patients, and the scores of the PSQI and SF-36 changed significantly both in CFS patients and healthy controls. 2) Sixty FCs were considered significant to discriminate CFS (P = 0.000, best accuracy 90%), with 80.5% ± 9% average accuracy. 3) The FCs that were majorly related to the left frontoparietal network (FPN) and default mode network (DMN) significantly increased (P = 0.0032 and P = 0.001) in CFS patients after Tai Chi exercise. 4) The change of FCs in the left FPN and DMN were positively correlated (r = 0.40, P = 0.012). CONCLUSION: These results demonstrated that the 60 FCs we found using machine learning could be neural biomarkers to discriminate between CFS patients and healthy controls. Tai Chi exercise may improve CFS patients' fatigue syndrome, sleep quality, and body health statement by strengthening the functional connectivity of the left FPN and DMN under these FCs. The findings promote our understanding of Tai Chi exercise's value in treating CFS.
150Enhancement of glymphatic function and cognition in chronic insomnia using low-frequency rTMS.PubMed
Chanjuan Zhang, Yadan Zheng, Guihua Jiang, et al.
Sleep. 2025 Jun 13;48(6). doi: 10.1093/sleep/zsaf083.
STUDY OBJECTIVES: Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) is a promising treatment for chronic insomnia; however, its effectiveness in improving cognitive and glymphatic clearance functions remains unclear. We aimed to investigate the effects of chronic insomnia on glymphatic clearance function and the effectiveness of LF-rTMS on chronic insomnia. METHODS: Thirty-two patients with chronic insomnia and 40 healthy controls underwent baseline assessments of clinical measures and glymphatic functions using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS). Thereafter, 22 patients underwent 10 sessions of LF-rTMS over two consecutive weeks, sleep assessments at week 2 and months 1, 2, and 3, and DTI-ALPS and cognitive-related assessments at week 2 and month 3. RESULTS: Compared to healthy controls, patients showed significant differences in the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Montreal Cognitive Assessment (MoCA) Scale, digit symbol substitution test (DSST), color trail test (CTT), digit span test (DST), Stroop tests, and DTI-ALPS index (all ps < 0.05). After LF-rTMS, patients showed a significant decrease in PSQI and ISI scores from week 2 onwards and significant improvement in MoCA, DSST, DST, CTT-B tests, and DTI-ALPS index by month 3 (all ps < 0.05). Furthermore, the increase in the DTI-ALPS index was significantly associated with improvements in PSQI, ISI, MoCA, and DST-backward at month 3 (r = 0.579, 0.558, 0.836, and 0.642, respectively, and p = 0.038, 0.047, <0.001, and 0.018, respectively). CONCLUSIONS: This study provided preliminary evidence for LF-rTMS' valuable effects on glymphatic clearance and cognitive function in patients with chronic insomnia, which supports LF-rTMS' clinical application in those population. CLINICAL TRIAL INFORMATION: This study has been officially registered with the Chinese Clinical Trial Registry. The trial, titled "Effect of Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Insomnia and the Underlying Brain Mechanism," is accessible via the following URL: https://www.chictr.org.cn/showproj.html?proj=205347. The registration number assigned to this trial is ChiCTR2300077939.
151Transcranial magnetic stimulation for sleep disorders in Alzheimer's disease: A double-blind, randomized, and sham-controlled pilot study.PubMed
Xiao Zhou, Yu Wang, Shuang Lv, et al.
Neurosci Lett. 2022 Jan 1;766:136337. doi: 10.1016/j.neulet.2021.136337. Epub 2021 Nov 8.
BACKGROUND: Sleep disorders are commonly comorbid with Alzheimer's disease (AD), And these disorders interfere with each other in many aspects. To date, pharmacological treatments for sleep disorders are still limited, and studies investigating repetitive transcranial magnetic stimulation (rTMS) for sleep disorders in AD are still lacking. METHOD: A single-center, randomized, double-blind, parallel-arm, and sham-controlled pilot study was conducted in AD patients with sleep disorders. Seventy subjects were randomly divided into the following two groups: the sham group (SG) and the intervention group (IG). We evaluated sleep changes using the Pittsburgh Sleep Quality Index (PSQI) before and after the intervention. We also assessed the patients' cognitive function by the Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-Cog). The intervention period was four weeks, and the patients were followed up in the 8th week to test the persistence of the effect of the rTMS intervention. RESULT: Significant differences in the PSQI scores were found between the SG and IG at the end of the 4-week intervention (P = 0.001) and the 8-week follow-up (P < 0.001). There was also significant improvement in ADAS-Cog scores (4 weeks: P = 0.048, 8 weeks: P = 0.038). Activities of daily living (ADL) did not significantly differ between the SG and IG. CONCLUSION: rTMS can effectively ameliorate sleep disorders in AD patients.
152Objective sleep enhancement in Parkinson's disease: A sham-controlled trial of low-frequency repetitive transcranial magnetic stimulation over the right dorsolateral prefrontal cortex.PubMed
Jiajing Wu, Sheng Zhuang, Xiaoying Zhang, et al.
Parkinsonism Relat Disord. 2024 Sep;126:107050. doi: 10.1016/j.parkreldis.2024.107050. Epub 2024 Jun 29.
INTRODUCTION: Parkinson's disease (PD) is often accompanied by sleep disturbances, impacting patients' quality of life. While repetitive transcranial magnetic stimulation (rTMS) shows promise in improving self-reported sleep quality, its effects on objective sleep architecture in PD remain understudied. Sleep disturbances, including rapid eye movement (REM) and slow-wave sleep disturbances, correlate with cognitive decline and motor symptoms. This study investigated the effect of low-frequency rTMS targeting the right dorsolateral prefrontal cortex (DLPFC) modifying objective sleep architecture and explored symptom improvement mechanisms in PD patients. METHODS: In this randomized, double-blind, sham-controlled trial, 67 PD patients received 10 consecutive days of 1-Hz rTMS over the right DLPFC. Polysomnography assessed sleep microstructure, while electroencephalogram recordings evaluated power spectral density and sleep spindle activity. Clinical scales measured sleep quality, motor symptoms, and cognition at baseline, post-treatment, and 3 months post-rTMS. RESULTS: The rTMS group exhibited improvements in sleep quality, motor symptoms, and cognition post-treatment, persisting at the 3-month follow-up. There was a notable increase in the REM sleep proportion post-rTMS. The rTMS group exhibited elevated low-frequency (0.5-2 Hz) slow-wave electroencephalogram spectral density during non-REM sleep. Cognitive enhancement correlated with increased lower delta power, while motor symptom progression correlated with spindle frequency and slow-wave sleep percentage changes. CONCLUSION: Low-frequency rTMS targeting the right DLPFC holds promise for improving clinical symptoms and modulating sleep architecture in PD. These findings suggest a link between symptom improvement and sleep structure enhancement, highlighting the need for further investigation into the therapeutic potential of rTMS in PD management.
153Repetitive Transcranial Magnetic Stimulation and Tai Chi Chuan for Older Adults With Sleep Disorders and Mild Cognitive Impairment: A Randomized Clinical Trial.PubMed
Zhizhen Liu, Lin Zhang, Linxin Bai, et al.
JAMA Netw Open. 2025 Jan 2;8(1):e2454307. doi: 10.1001/jamanetworkopen.2024.54307.
IMPORTANCE: Sleep disorders and mild cognitive impairment (MCI) commonly coexist in older adults, increasing their risk of developing dementia. Long-term tai chi chuan has been proven to improve sleep quality in older adults. However, their adherence to extended training regimens can be challenging. Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulation technique that may enhance the benefits of exercise. OBJECTIVE: To investigate whether 1-Hz rTMS of the right dorsolateral prefrontal cortex could enhance the clinical benefits of tai chi chuan in improving sleep quality and cognitive function among older adults with sleep disorders and MCI. DESIGN, SETTING, AND PARTICIPANTS: This 2-arm, sham-controlled, assessor-masked randomized clinical trial was conducted at a university hospital in China between October 2022 and February 2024. Adults aged 60 to 75 years with sleep disorders and MCI were eligible. Data analysis was performed from February to May 2024. INTERVENTION: Participants were randomized in a 1:1 ratio to an experimental group (tai chi chuan and 1-Hz rTMS) or a sham group (tai chi chuan and sham rTMS). Each participant received 30 sessions of personalized rTMS targeting the right dorsolateral prefrontal cortex, and the sham group underwent the same procedure. The 2 groups received 30 sessions of 60 minutes of the 24-form simplified tai chi chuan, 5 times per week for 6 weeks. MAIN OUTCOMES AND MEASURES: The primary outcomes were subjective sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), in which scores range from 0 to 21, with lower scores indicating a healthier sleep quality, and global cognitive function assessed by the Montreal Cognitive Assessment (MoCA), in which scores range from 0 to 30, with higher scores indicating less cognitive impairment. The secondary outcomes included measures of objective sleep actigraphy, anxiety and depression scales, and other cognitive subdomains. Assessments were performed at baseline, 6 weeks after the intervention, and at the 12-week follow-up. RESULTS: A total of 110 participants (mean [SD] age, 67.9 [4.6] years; 68 female [61.8%]) were randomized to the experimental group (n = 55) and the sham group (n = 55) and included in the intention-to-treat analysis. At 6 weeks after the intervention, compared with the sham group, the experimental group showed a lower PSQI score (between-group mean difference, -3.1 [95% CI, -4.2 to -2.1]; P < .001) and a higher MoCA score (between-group mean difference, 1.4 [95% CI, 0.7-2.1]; P < .001). The per-protocol dataset analyses and 12-week follow-up showed similar results. The generalized estimated equation model revealed an interaction effect between the PSQI score (mean difference, -2.1 [95% CI, -3.1 to -0.1]; P < .001) and the MoCA total score (mean difference, 0.9 [95% CI, 0.1-1.6]; P = .01). There were 7 nonserious, unrelated adverse events (experimental group: 2; sham group: 5) with no significant difference between the 2 groups. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the findings suggest that 1-Hz rTMS enhanced the clinical benefits of tai chi chuan in improving sleep quality and cognitive function among older adults with sleep disorders and MCI, which may be related to alterations in neural plasticity. These findings provide novel data on nonpharmacologic strategies for the rehabilitation of sleep disorders and may delay or even prevent MCI. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2200063274.
154Effect of combined Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults: A randomized controlled trial.PubMed
Jiali He, Sunny H W Chan, Raymond C K Chung, et al.
J Psychiatr Res. 2024 Dec;180:281-290. doi: 10.1016/j.jpsychires.2024.10.025. Epub 2024 Oct 26.
BACKGROUND AND AIMS: Novel approaches to improve sleep disturbance in older adults are needed. Our study comprises a pioneering attempt to test the efficacy of Tai Chi (TC) combined with repetitive transcranial magnetic stimulation (rTMS) in improving sleep disturbance in older adults. The influence of baseline depressive symptoms was tested in a subset of the sample. METHOD: In the randomized controlled trial, 152 participants were each allocated to one of the following groups: (1) TC plus active rTMS (n = 38), (2) TC plus sham rTMS (n = 38), (3) TC alone (n = 38), and (4) low-intensity physical exercise (PE) control group (n = 38). Four-week interventions were conducted for each group. The outcomes included insomnia severity, actigraphy-assessed and self-reported sleep parameters, mood states, and quality of life. Assessments were carried out at baseline (T0), post-intervention (T1), and 3-month follow-up (T2). RESULTS: Of the 152 randomized participants, the mean (SD) age was 67.68 (4.98) years, with 112 female (73.68%). The findings revealed that TC plus active rTMS induced a significant reduction in actigraphy-assessed sleep onset latency compared to TC plus sham rTMS at T1 and T2. In the subsample without depressive symptoms, the combination treatment exhibited a greater benefit in actigraphy-assessed sleep efficiency and wake time after sleep onset compared to both variables in the PE group and in the sham comparator group at T1, respectively. The other subsample with depressive symptoms showed the improvements with TC plus active rTMS, TC plus sham rTMS, and TC alone differed significantly from PE at T1 and T2. CONCLUSIONS: This study has demonstrated the positive effect of TC combined with rTMS on sleep disturbance in older adults. Specific sample characteristics should be considered when applying TC, either alone or combined with rTMS.
155Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial.PubMed
Jiali He, Sunny Hw Chan, Jingxia Lin, et al.
Sleep Med. 2024 Oct;122:35-44. doi: 10.1016/j.sleep.2024.07.029. Epub 2024 Aug 2.
BACKGROUND: The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances. METHODS: Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2). RESULTS: Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity. CONCLUSION: The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.
156Insomnia and menopause: a narrative review on mechanisms and treatments.PubMed
P Proserpio, S Marra, C Campana, et al.
Climacteric. 2020 Dec;23(6):539-549. doi: 10.1080/13697137.2020.1799973. Epub 2020 Sep 3.
The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk-benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.
157Sleep and Sleep Disorders in the Menopausal Transition.PubMed
Fiona C Baker, Laura Lampio, Tarja Saaresranta, et al.
Sleep Med Clin. 2018 Sep;13(3):443-456. doi: 10.1016/j.jsmc.2018.04.011.
The menopausal transition is associated with an increase in insomnia symptoms, especially difficulty staying asleep, which negatively impacts quality of life. Vasomotor symptoms are a key component of sleep disruption. Findings from polysomnographic studies are less consistent in showing disrupted sleep in menopausal transition independent of aging; further prospective studies are needed. Hormone therapy alleviates subjective sleep disturbances, particularly if vasomotor symptoms are present. However, because of contraindications, other options should be considered. Further work is needed to develop preventive and treatment strategies for alleviating sleep disturbances to ensure better health, quality of life, and productivity in midlife women.
158Sleep disturbance associated with the menopause.PubMed
Pauline M Maki, Nick Panay, James A Simon
Menopause. 2024 Aug 1;31(8):724-733. doi: 10.1097/GME.0000000000002386. Epub 2024 Jun 25.
IMPORTANCE AND OBJECTIVES: Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition. METHODS: We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices. DISCUSSION AND CONCLUSIONS: Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.
159Fezolinetant: A Potential Treatment for Moderate to Severe Vasomotor Symptoms of Menopause.PubMed
Barbara DePree
touchREV Endocrinol. 2023 Nov;19(2):69-72. doi: 10.17925/EE.2023.19.2.13. Epub 2023 Jun 15.
The most common symptom of menopause is vasomotor symptoms (VMS), which occur in more than 80% of postmenopausal women. Furthermore, VMS are the manifestation of menopause for which women most commonly seek treatment, namely, to address their impacted quality of life, including sleep, and work-and non-work-related productivity. VMS vary in frequency, intensity and duration. Hormone therapy (HT) has been our most effective treatment for VMS and has been approved for this indication by the United States Food and Drug Administration (FDA). Despite being a safe and effective treatment option, many patients and providers are hesitant to consider HT. Moreover, HT is contraindicated for some women. While many over-the-counter and non-HT options are available, we lack data on the efficacy and safety of most of these. This has left a void for women. Fezolinetant was recently approved by the FDA for the treatment of moderate-to-severe VMS. So far, clinical trials have shown positive results in terms of safety and efficacy. Fezolinetant is a non-hormonal, neurokinin 3 receptor antagonist that works in the hypothalamus at the thermoregulatory centre. Blocking the non-hormonal neurokinin 3 receptor antagonist modulates hot flashes and night sweats. As early as 4 weeks from initiating fezolinetant, women experienced a statistically significant reduction of both severity and frequency of VMS per day, resulting in an improved quality of life.
160Hormonal and non-hormonal interventions for menopausal symptoms.PubMed
J Coope
Maturitas. 1996 Mar;23(2):159-68. doi: 10.1016/0378-5122(95)00971-x.
Recent cohort studies confirm that only flushes, night sweats and vaginal dryness are provenly associated with ovarian failure. Experiments nave demonstrated that these symptoms and insomnia associated with nocturnal vasomotor symptoms are more effectively controlled by oestrogen than placebo. Hormonal interventions include a variety of oestrogen or oestrogen/progestogen regimes. Non-hormonal treatments of flushes include exercise, paced respiration and psychotherapy. After the menopause vaginal atrophy and some urinary symptoms respond to local oestrogen and vaginal dryness in also prevented by lubricants. Libido is not increased by oestrogen therapy but may be improved by testosterone. Depression is common in middle-aged women but is not specifically associated with the hormonal changes occurring at the menopause. Oestrogen therapy may improve and stabilise mood during the peri-menopause but there is no firm evidence that it is effective for depression after the menopause. Arthralgia is not a symptom specific to menopause and experimental evidence concerning the role of oestrogen in the treatment of rheumatoid arthritis is inconclusive. Cognitive function is not related to menopause and measures such as stopping smoking, exercise and maintaining body weight may be partly effective in preventing menopausal symptoms.
161An integrated approach to diagnosing and managing sleep disorders in menopausal women.PubMed
Marta Caretto, Andrea Giannini, Tommaso Simoncini
Maturitas. 2019 Oct;128:1-3. doi: 10.1016/j.maturitas.2019.06.008. Epub 2019 Jun 28.
Sleep disorders increase in prevalence during the menopausal transition and they constitute a complex phenomenon. Insomnia, the main sleep disorder, can be a primary disorder or it can be secondary to hot flushes (HF), mood disorders, psychosocial factors, medical conditions, and other sleep disturbances, such as obstructive sleep apnoea (OSA) or restless legs syndrome (RLS). Menopausal women complaining of persistent sleep disorders should be referred to a sleep specialist for comprehensive sleep management because unrecognized and untreated sleep disorders can have dramatic health-related consequences. Women suffering from insomnia related to vasomotor symptoms (VMS) can be treated with hormone replacement therapy (HRT). Primary insomnia will be preferentially improved with cognitive behavioural therapy (CBT-I) or with non-benzodiazepine hypnotics or melatonin. CBT-I is a highly efficacious treatment for postmenopausal women with insomnia. Using antidepressants to treat sleep disruption in the absence of depression is not recommended; instead, the United States Food and Drug Administration (FDA) approved paroxetine as the first non-hormonal treatment for HF. Sleep disorders in menopausal women should not be underestimated. It is necessary to diagnose the specific causal disorder and then to provide treatment to improve sleep quality and quality of life.
162Validation of the Women's Health Initiative Insomnia Rating Scale in a multicenter controlled clinical trial.PubMed
Douglas W Levine, Margaret E Dailey, Beverly Rockhill, et al.
Psychosom Med. 2005 Jan-Feb;67(1):98-104. doi: 10.1097/01.psy.0000151743.58067.f0.
OBJECTIVE: The objective of this study was to evaluate the construct validity of the five-item Women's Health Initiative Insomnia Rating Scale (WHIIRS) by comparing women taking hormone therapy (HT) versus those taking a placebo and by comparing women known to differ in vasomotor symptoms. METHODS: The WHIIRS was included in two phase III randomized trials intended to evaluate the efficacy of a combination estradiol plus and norethindrone acetate transdermal delivery system in reducing vasomotor symptoms. In all, 850 healthy postmenopausal women participated in these studies. Both trials were double-blind, one was placebo-controlled and the other was positive-controlled. The former trial admitted women with > or =8 hot flashes/day and lasted 12 weeks with data collected on the WHIIRS at baseline, 4, 8, and 12 weeks. The other trial had no entry criteria pertaining to hot flashes and lasted 52 weeks with WHIIRS data collected at baseline, 12, 24, and 52 weeks. RESULTS: The WHIIRS was sensitive to the effect of HT on sleep disturbance over time. The WHIIRS also detected differences in self-reported sleep disturbance between women with mild vasomotor symptoms compared with those with moderate to severe symptoms. As expected, the study using a positive control revealed that sleep improved over time (p <.0001). Also as predicted, the study using a placebo control found that sleep disturbance in the treatment groups improved at a faster rate than in the control groups (p = .035). CONCLUSION: The construct validity of the WHIIRS was supported because it was successfully used to detect self-reported sleep disturbance differences in women taking HT versus those taking a placebo as well as in groups known to differ in severity of their vasomotor symptoms.
163Cognitive behavioral therapy for menopausal symptoms.PubMed
M S Hunter
Climacteric. 2021 Feb;24(1):51-56. doi: 10.1080/13697137.2020.1777965. Epub 2020 Jul 6.
This article describes cognitive behavioral therapy (CBT) for women with problematic menopausal symptoms, and provides the evidence from clinical trials of women going through the menopause, women with breast cancer treatment-induced symptoms and women with problematic symptoms in a work context. The CBT focus is primarily on vasomotor symptoms (VMS) but it also targets stress, low mood and sleep problems. CBT is a brief therapy (four to six sessions) that is theory- and evidence-based; it is acceptable to women and effectively reduces the impact of VMS, improves sleep and has benefits to quality of life. VMS frequency is also reduced significantly in some trials but not others. CBT has been found to be consistently effective when delivered in groups, self-help book and on-line formats (with or without additional support). The MENOS 1 and MENOS 2 CBT protocols are recommended for the treatment of VMS by the North American Menopause Society (2015); CBT has been recommended for the treatment of anxiety and depression for women during the menopause transition and post menopause (NICE, 2015); and telephone CBT has been shown to be an effective treatment for insomnia.
164Chronotype and Sleep Quality in Obesity: How Do They Change After Menopause?PubMed
Ludovica Verde, Luigi Barrea, Claudia Vetrani, et al.
Curr Obes Rep. 2022 Dec;11(4):254-262. doi: 10.1007/s13679-022-00479-9. Epub 2022 Sep 2.
PURPOSE OF REVIEW: This review primarily provides an overview of the current evidence on chronotype (which reflects an individual's preference for the timing of sleeping, eating, and activity in a 24-h period) and sleep quality changes in obesity in postmenopausal women. It also explores possible nutritional strategies to manage these changes in this phase of a woman's life. RECENT FINDINGS: Menopause is a life stage frequently associated with sleep disturbances and changes in circadian rhythms. Sleep disturbances are one of the main symptoms of menopause and are caused by several factors such as hormonal changes, obesity, and melatonin reduction. In addition, the chronotype also changes following menopause. Nutritional strategies are essential because they could help manage menopausal sleep disturbances and circadian misalignment, particularly by tackling obesity and overweight. In the management of postmenopausal women, especially those experiencing obesity, careful assessment of sleep disturbances and chronotype and subsequent development of the most appropriate treatment, including nutritional management, should be part of the treatment routine.
165A review of non-hormonal options for the relief of menopausal symptoms.PubMed
Paola Albertazzi
Treat Endocrinol. 2006;5(2):101-13. doi: 10.2165/00024677-200605020-00004.
The climacteric syndrome involves a variety of symptoms such as profuse sweating, insomnia, memory loss, decreased sexual drives, joint aches, and anxiety. However, amongst these symptoms, hot flashes and sweats are generally considered the hallmark and result in the majority of the medical consultations for this condition. Hot flashes are known to respond readily to placebo, which alone decreases their frequency by 20-40%. In the ideal setting of clinical trials, with optimal patient selection and compliance, estrogen therapy reduces hot flashes by about 70-80%; this is twice as effective as placebo. However, estrogen is unable to be universally used, either because of contraindications or because of an unwillingness of women to take it. Furthermore, hot flashes may persist in spite of adequate estrogen replacement, and physicians are often faced with the dilemma of finding something to administer in place of, or in addition to, estrogen to improve symptoms. The most commonly used non-hormonal alternatives for climacteric symptoms are neurotransmitter modulators such as serotonin reuptake inhibitors and gabapentin. These are, at best, approximately half as effective as estrogen for the relief of menopausal symptoms, and are only marginally better than placebo.Complementary treatment, particularly over-the-counter phytotherapeutic extracts, are very popular and women often try a variety of such products before resorting to conventional medicine. Preparations containing isoflavones, such as soy extract and red clover or extracts from evening primrose or cimicifuga (black cohosh, Actaea racemosa, syn. Cimicifuga racemosa), in variable doses are very popular for the treatment of hot flashes. The scientific support for their efficacy certainly does not equal their popularity.Non-hormonal treatments for menopause are not as effective as estrogens in relieving hot flashes, but may have a role in therapy for women who have contraindications to gonadal steroid use.
166A profile of safety and efficacy of fezolinetant for the treatment of menopausal vasomotor symptoms.PubMed
Laura Cucinella, Chiara Cassani, Sara Tedeschi, et al.
Expert Rev Clin Pharmacol. 2025 May;18(5):247-258. doi: 10.1080/17512433.2025.2495951. Epub 2025 Apr 21.
INTRODUCTION: Fezolinetant is a first-in-class non-hormonal pharmacological treatment recently approved for moderate-to-severe vasomotor symptoms (VMS) associated with menopause. Its mechanism of action selectively targets the pathophysiology of VMS at hypothalamic level, antagonizing binding of neurokinin B, overexpressed in estrogen deprived menopausal women, to the neurokinin 3 receptor (NK3R) in the thermoregulatory center. AREAS COVERED: Fezolinetant reduced VMS frequency and severity in phase 3 randomized placebo-controlled trials in healthy menopausal women (SKYLIGHT 1 and 2) and in women unsuitable for menopause hormone therapy (MHT) (DAYLIGHT). The effect on VMS positively translated into improvements in menopause-specific quality of life, as well as sleep disturbances and impairment. Safety data were reassuring across studies, especially 52-weeks safety trials (SKYLIGHT 4 and MOONLIGHT 3). EXPERT OPINION: Fezolinetant represents a highly anticipated innovation, offering the possibility to bridge the therapeutic gap for many women who cannot or do not wish to use MHT. While the potential application of fezolinetant in some clinical settings will add substantial value to the management of VMS, some research gaps need to be addressed in order to provide meaningful insight into the benefit-risk profile that ultimately will improve counseling and prescription tailoring in symptomatic menopausal women.
167Sleep disturbance and menopause.PubMed
Nicole E Carmona, Natalie L Solomon, Karen E Adams
Curr Opin Obstet Gynecol. 2025 Apr 1;37(2):75-82. doi: 10.1097/GCO.0000000000001012. Epub 2025 Jan 17.
PURPOSE OF REVIEW: Sleep problems are among the most prevalent and bothersome symptoms of menopause. This review characterizes menopausal sleep disturbances, describes biopsychosocial predictors, and summarizes the evidence supporting pharmacological and nonpharmacological treatment options. RECENT FINDINGS: Recent studies found that sleep changes are early indicators of perimenopause and sought to disentangle the respective impacts of menopausal status, hot flashes (HFs), and changes in reproductive hormones on peri-/postmenopausal sleep problems. Both HFs and reproductive hormones predicted sleep problems, but neither solely accounted for the myriad changes in sleep, thus highlighting the contribution of additional biopsychosocial risk factors. Inconsistencies across studies were likely due to differences in study design and methodology, participants' menopausal stage, and the presence of sleep complaints. Recent studies support the use of psychological (cognitive-behavioral therapy for insomnia) and pharmacological (e.g., neurokinin B antagonists) treatments in addition to hormone therapy. SUMMARY: Sleep problems are common and of critical import to women during the menopausal transition, significantly influencing treatment preferences and satisfaction. Thus, sleep problems should be routinely assessed from a biopsychosocial perspective and treated with evidence-based interventions throughout menopause. Treatment selection should be based on diagnosis and careful assessment.
168Pharmacokinetic evaluation of fezolinetant for the treatment of vasomotor symptoms caused by menopause.PubMed
Laura Cucinella, Sara Tedeschi, Stefano Memoli, et al.
Expert Opin Drug Metab Toxicol. 2025 Jan-Feb;21(2):105-113. doi: 10.1080/17425255.2024.2416046. Epub 2024 Oct 16.
INTRODUCTION: Vasomotor symptoms (VMS) affect the majority of menopausal women, with possible negative impact on several domains of quality of life (QoL). Although menopausal hormone therapy (MHT) represents an effective treatment, the risk-benefit profile is not favorable for every woman. Non-hormonal options are limited in number and efficacy. AREAS COVERED: Fezolinetant is a novel oral non-hormonal drug recently approved for the treatment of moderate-severe VMS. It acts as an antagonist of neurokinin 3 receptor (NK3R), the main target of neurokinin B (a tachykinin over-expressed by kisspeptin/neurokinin B/dynorphin [KNDy] neurons after menopausal hypoestrogenism), involved in the modulation of the thermoregulatory hypothalamic center. Here, we report pharmacodynamics and pharmacokinetic properties of fezolinetant as well as its efficacy and safety data from available clinical trials. EXPERT OPINION: Fezolinetant has shown efficacy in reducing the frequency and severity of VMS with a positive impact on sleep- and health-related QoL and acceptable safety and tolerability profile. Given the limited availability of effective non-hormonal options for VMS, fezolinetant could potentially represent a game-changer for care of menopausal women, especially when relative or absolute contraindications to MHT use are present. Further studies to gain more information about the safety profile and potential extra-VMS benefits or disadvantages are warranted in real-life clinical practice.
169Targeting vasomotor symptoms with the new drug fezolinetant - an expert overview.PubMed
Rossella E Nappi, Angelo Cagnacci, Costantino Di Carlo, et al.
Gynecol Endocrinol. 2025 Dec;41(1):2526560. doi: 10.1080/09513590.2025.2526560. Epub 2025 Jul 8.
Menopause is an inevitable event in the life of women who live long enough to reach this milestone. The experience of menopause varies amongst individuals. Menopause has a negative impact on women's life and is associated with symptoms including vasomotor symptoms (VMS), such as hot flushes and night sweats, sleep disturbances and low mood. VMS are bothersome and may have a long duration. Menopause hormone therapy (MHT) is recommended in women with symptoms; however, its use is limited. The recent approval of fezolinetant offers a new therapeutic option for women who suffer from VMS and are unsuitable or averse to MHT. Fezolinetant is a precision drug as it targets the pathological mechanism of VMS showing some effect also on sleep disturbances. Given how variable the experience of menopause is, it is important to offer individualized treatment options to women who suffer from menopause-related symptoms and let them be part of the shared decision making.
170Mind-body therapies for sleep disturbances, depression, and anxiety in menopausal women: a systematic review and meta-analysis of randomized controlled trials.PubMed
Zhixin Fan, Yifan Zhang, Yankai Shu, et al.
Front Public Health. 2025 Nov 18;13:1686981. doi: 10.3389/fpubh.2025.1686981. eCollection 2025.
BACKGROUND: Menopause is frequently accompanied by sleep disturbances, depression, and anxiety, negatively affecting women's quality of life. While hormone therapy can be effective, safety concerns highlight the need for accessible non-pharmacological options. Mind-body therapies (MBTs) have emerged as promising interventions, yet their overall efficacy remains unclear. METHODS: A systematic review and meta-analysis were conducted on randomized controlled trials evaluating the effects of MBTs-such as Yoga, Mindfulness, Qigong, Art therapy, Music therapy, Dance therapy and Reiki-on sleep, depression, and anxiety in perimenopausal and postmenopausal women. Comparator groups included usual care or no-intervention controls. Eighteen studies involving 1,572 participants were identified through PubMed, Embase, Cochrane Library, and Web of Science (through October 10, 2025). Random-effects models were applied, along with subgroup, sensitivity, and publication bias analyses. RESULTS: MBTs significantly improved sleep quality (SMD = -0.86; 95% CI: -1.24 to -0.48), reduced depression (SMD = -0.79; 95% CI: -1.18 to -0.40), and alleviated anxiety (SMD = -1.13; 95% CI: -1.66 to -0.59), showing moderate-to-large effects. Subgroup analyses showed that mindfulness, music therapy, dance therapy, and Reiki yielded greater psychological benefits than yoga and Qigong. Longer interventions (≥12 weeks) and studies from Asia showed stronger effects, possibly due to differences in intervention type, cultural familiarity, or adherence. Sensitivity analyses confirmed robust results, and no publication bias was detected. CONCLUSION: MBTs offer moderate-to-large benefits and represent safe, low-risk strategies for managing menopausal symptoms. Expressive approaches, including Mindfulness, Music therapy, and Dance therapy, may provide added value for emotional regulation and psychological well-being. Yoga and Qigong provide stable benefits for sleep improvement. High-quality trials are needed to inform clinical guidelines. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251103844.
171The prevalence and association of stress with sleep quality among medical students.PubMed
Abdullah I Almojali, Sami A Almalki, Ali S Alothman, et al.
J Epidemiol Glob Health. 2017 Sep;7(3):169-174. doi: 10.1016/j.jegh.2017.04.005. Epub 2017 May 5.
INTRODUCTION: Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. METHODS: This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. RESULTS: A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (p<0.001). Logistic regression indicated that students who are not suffering from stress are less likely to have poor sleep quality (OR=0.28, p<0.001), and the risk of having poor sleep quality is almost four times higher in students whose cumulative grade point average (GPA) is less than 4.25 (OR=3.83, p=0.01). CONCLUSION: The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students' study skills and coping with their stressful environment.
172Prediction of sleep quality among university students after analyzing lifestyles, sports habits, and mental health.PubMed
Lirong Zhang, Hua Zheng, Min Yi, et al.
Front Psychiatry. 2022 Aug 4;13:927619. doi: 10.3389/fpsyt.2022.927619. eCollection 2022.
The aim of this study was to develop and validate a prediction model to evaluate the risk of poor sleep quality. We performed a cross-sectional study and enrolled 1,928 college students from five universities between September and November 2021. The quality of sleep was evaluated using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Participants were divided into a training ( = 1,555) group and a validation ( = 373) group. The training group was used to establish the model, and the validation group was used to validate the predictive effectiveness of the model. The risk classification of all participants was performed based on the optimal threshold of the model. Of all enrolled participants, 45.07% (869/1,928) had poor sleep quality (PSQI score ≧ 6 points). Multivariate analysis showed that factors such as older age, a higher grade, previous smoking, drinking, midday rest, chronic disease, anxiety, and stress were significantly associated with a higher rate of poor sleep quality, while preference for vegetables was significantly associated with better sleep quality, and all these variables were included to develop the prediction model. The area under the curve (AUC) was 0.765 [95% confidence interval (CI): 0.742-0.789] in the training group and 0.715 (95% CI: 0.664-0.766) in the validation group. Corresponding discrimination slopes were 0.207 and 0.167, respectively, and Brier scores were 0.195 and 0.221, respectively. Calibration curves showed favorable matched consistency between the predicted and actual probability of poor sleep quality in both groups. Based on the optimal threshold, the actual probability of poor sleep quality was 29.03% (317/1,092) in the low-risk group and 66.03% (552/836) in the high-risk group ( < 0.001). A nomogram was presented to calculate the probability of poor sleep quality to promote the applicationof the model. The prediction model can be a helpful tool to stratify sleep quality, especially among university students. Some intervention measures or preventive strategies to quit smoking and drinking, eat more vegetables, avoid midday rest, treat chronic disease, and alleviate anxiety and stress may be considerably beneficial in improving sleep quality.
173Association between sleep hygiene awareness and practice with sleep quality among Kuwait University students.PubMed
S Al-Kandari, A Alsalem, S Al-Mutairi, et al.
Sleep Health. 2017 Oct;3(5):342-347. doi: 10.1016/j.sleh.2017.06.004. Epub 2017 Aug 10.
University students are especially vulnerable to poor sleep quality. The aim of this study was to assess students' sleep hygiene awareness and sleep hygiene practices, and evaluate their sleep quality. The association of sleep quality with sleep hygiene awareness and practice was also explored. The median sleep quality score was 7; scores more than 5 indicate poor sleep quality. Hence, a large proportion of Kuwait University students experience a suboptimal level of overall sleep quality according to the Pittsburgh Sleep Quality Index criteria. Sleep hygiene knowledge among university students was relatively inadequate. Most respondents (60.9%) failed to recognize that taking a nap during daytime might be disruptive to sleep. Sleep quality was strongly correlated with sleep hygiene practice (Spearman rank correlation, r=0.267, P<.001) but not with sleep hygiene knowledge. Medical students showed poorer sleep hygiene awareness and poor sleep quality compared with students from other universities. Logistic regression analysis showed that female sex (adjusted odds ratio [OR]=1.8, P<.001), college (OR=2.2, P<.001), grade point average (OR=2.8, P=.023), and sleep hygiene practice score were independently associated with sleep quality after adjusting for confounders. In conclusion, a large proportion of Kuwait University students experience poor sleep quality. Therefore, the development of sleep hygiene education programs as an intervention and prevention strategy is recommended. This will improve students' knowledge on the importance of adopting healthy sleep hygiene practices for better sleep quality and enhanced academic performance.
174Effect of Smartphone Use on Sleep in Undergraduate Medical Students: A Cross-Sectional Study.PubMed
Ashish Goel, Arsalan Moinuddin, Rajesh Tiwari, et al.
Healthcare (Basel). 2023 Nov 2;11(21):2891. doi: 10.3390/healthcare11212891.
Smartphone use, particularly at night, has been shown to provoke various circadian sleep-wake rhythm disorders such as insomnia and excessive daytime tiredness. This relationship has been mainly scrutinized among patient groups with higher rates of smartphone usage, particularly adolescents and children. However, it remains obscure how smartphone usage impacts sleep parameters in adults, especially undergraduate college students. This study sought to (1) investigate the association between smartphone use (actual screen time) and four sleep parameters: Pittsburgh sleep quality score (PSQI), self-reported screen time, bedtime, and rise time; (2) compare the seven PSQI components between good and poor sleep quality subjects. In total, 264 undergraduate medical students (aged 17 to 25 years) were recruited from the Government Doon Medical College, Dehradun, India. All participants completed a sleep questionnaire, which was electronically shared via a WhatsApp invitation link. Hierarchical and multinomial regression analyses were performed in relation to (1) and (2). The average PSQI score was 5.03 ± 0.86, with approximately one in two respondents (48.3%) having a poor sleep index. Smartphone use significantly predicted respondents' PSQI score (β = 0.142, = 0.040, R = 0.027), perceived screen time (β = 0.113, = 0.043, R = 343), bedtime (β = 0.106, = 0.042, R = 045), and rise time (β = 0.174, = 0.015, R = 0.028). When comparing poor-quality sleep (PSQI ≥ 5) to good-quality sleep (PSQI < 5), with good-quality sleep as the reference, except sleep efficiency and sleep medications ( > 0.05), five PSQI components declined significantly: subjective sleep quality (β = -0.096, < 0.001); sleep latency (β = -0.034, < 0.001); sleep duration (β = -0.038, < 0.001); sleep disturbances (β = 1.234, < 0.001); and sleep dysfunction (β = -0.077, < 0.001). Consequently, public health policymakers should take this evidence into account when developing guidelines around smartphone use-i.e., the when, where, and how much smartphone use-to promote improved sleep behaviour and reduce the rate of sleep-wake rhythm disorders.
175Effects of perceived stress on college students' sleep quality: a moderated chain mediation model.PubMed
Yaqing Huang, Lei Yang, Yang Liu, et al.
BMC Psychol. 2024 Sep 10;12(1):476. doi: 10.1186/s40359-024-01976-3.
BACKGROUND: Perceived Stress has been shown as a key contributor to sleep quality, but the underlying mechanism between perceived stress and sleep quality remains unknown. This study aimed to investigate the impact of perceived stress on sleep quality of college students and the chain mediating roles of presence of meaning in life (PML) and depression, as well as the moderating role of search for meaning in life (SML). METHODS: Participants were 8178 college students (4599 boys and 3579 girls; Mage = 19.10 years, SD = 1.08) who completed self-report questionnaire, including the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), the Meaning in Life Questionnaire (MLQ), and the Patient Health Questionnaire-9 (PHQ-9). RESULTS: The results showed that higher perceived stress was directly related to poorer sleep quality. This negative impact on sleep quality was mediated through the chained roles of PML and depression. Additionally, the study found that SML moderates the influence of perceived stress, PML and depression on sleep quality. Specifically, for individuals actively search for meaning, the adverse effects of perceived stress and depression on sleep quality are diminished. Concurrently, the positive influence of PML on sleep quality is enhanced. CONCLUSION: This study revealed that the PML and depression mediate the effect of perceived stress on sleep quality, with SML playing a significant protective role. These results emphasize the necessity of integrating strategies to enhance PML and SML into interventions designed to improve emotion management and sleep quality among college students.
176Screen Time Among Medical and Nursing Students and Its Correlation With Sleep Quality and Attention Span: A Cross-Sectional Study.PubMed
Dinesh P Sahu, Manish Taywade, Poojitha Sushma Malla, et al.
Cureus. 2024 Apr 15;16(4):e58323. doi: 10.7759/cureus.58323. eCollection 2024 Apr.
BACKGROUND: Screen time is increasing among students and is also known to affect their lifestyle and health. The study investigated the correlation of screen time with sleep quality and attention span. METHODS: A cross-sectional study was conducted among undergraduate medical and nursing students in November 2021. A total of 192 students were selected randomly and investigated using a structured questionnaire. Sleep behavior was assessed using the Pittsburg Sleep Quality Index. Screen time and attention span were measured for each participant. The screen time data was reported as the median with an IQR. Pearson's correlation was performed to assess the correlation between screen time and sleep behavior and screen time and attention span. RESULTS: The median screen time for 28 days was 260 (192.2-326.7) hours, and the median non-academic screen time was 250.0 (172.3-328.0) hours. Subjective sleep quality was good among 163 (84.9%) of the study participants. Global sleep quality was poor among 91 (42.2%) participants. The median score of the digit span forward was 6.00 (IQR: 5.00-7.00), and the median score of the digit span backward was 5.00 (IQR: 4.00-6.00). The global sleep score had a strong positive correlation with screen time, with a Pearson's correlation coefficient of 0.86. Forward and backward attention spans were not correlated with sleep scores, with correlation coefficients of 0.037 and 0.071, respectively. CONCLUSION: Screen time is increasing significantly among medical and nursing undergraduate students, and their sleep is also getting affected. Emphasis should be given to the balance between digitalization and health.
177Electronic Gadget Screen-time, Perceived Sleep Quality & Quantity and Academic Performance in Medical Students.PubMed
Koushik Yeluri, Kiran Hs, Basavana Gowdappa H, et al.
J Assoc Physicians India. 2021 Nov;69(11):11-12.
BACKGROUND: Exposure to blue light has been found to affect sleep. Reduced sleep has been found to affect academic performance. However, electronic gadget screen time, sleep quality and quantity and academic performance in undergraduate medical students has not been explored so far. The primary objective of this study was to explore Electronic Gadget Screen time, sleep quality, and sleep quantity and academic performance in Medical students. METHODS: The study was done in JSS Medical College, Mysuru. 400 students fromunder graduate course were selected through clustered random sampling. Data of electronic gadget usage was collected using a pre-tested proforma. Data of sleep quality, quantity was collected using Pittsburg Sleep Quality Index. Data of academic performance was collected from the marks sheet provided by the college authorities. RESULTS: Average screen time overall was 5.13 hours per day. On the whole, total Screen time does not have a direct relationship with sleep quantity or quality or academic performance. Rather than the total screen time, bed time gadget use seems to have a more significant relationship with academic performance. A non-significant relationship has been identified between screen time and quality of sleep with a p value= 0.2. Higher academic performance correlated with better sleep quality and better global PSQI scores. CONCLUSION: Bed time screen exposure plays a significant role in determining sleep quality, quantity and in turn academic performance.
178Screen time and sleep among medical students in Germany.PubMed
Lukas Liebig, Antje Bergmann, Karen Voigt, et al.
Sci Rep. 2023 Sep 19;13(1):15462. doi: 10.1038/s41598-023-42039-8.
Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = - 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.
179Sleep quality and associated factors among undergraduate medical students during Covid-19 confinement.PubMed
Jayanti Mishra, Ansuman Panigrahi, Priyadarsini Samanta, et al.
Clin Epidemiol Glob Health. 2022 May-Jun;15:101004. doi: 10.1016/j.cegh.2022.101004. Epub 2022 Mar 11.
PROBLEM CONSIDERED: Medical students are vulnerable to poor sleep quality which may lead to attention difficulties and poor academic performance. Good quality sleep is needed for optimal neurocognitive and psychomotor functions as well as physical and mental health. This study aimed to assess the prevalence of poor sleep quality among undergraduate medical students during home confinement at the time of Covid-19 pandemic and analyze the relationship between sleep quality and relevant socio-demographic and psychological variables. METHODS: A cross-sectional study was conducted among 284 undergraduate medical students of a teaching hospital of Bhubaneswar from October-November 2020. Using a semi-structured questionnaire, relevant information was collected. Sleep quality of the students was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and mental health status of the students using Depression, Anxiety, and Stress Scale - 21 (DASS-21). RESULTS: The prevalence of poor sleep quality among undergraduate medical students was 45%. Multivariate logistic regression revealed that students doing exercise for <3 days/week (AOR: 1.81, 95% CI: 1.01-3.23), spending ≥8 h screen time/day (AOR: 2.02, 95%: 1.12-3.66), having anxiety symptoms (AOR: 3.61, 95% CI: 1.72-7.57), and those who were not satisfied with own self (AOR: 2.69, 95% CI: 1.35-5.38) were more likely to report poor sleep quality. CONCLUSION: Poor sleep quality was prevalent among undergraduate medical students during their home confinement at the time of Covid-19 pandemic. Sleep educational programs, anxiety management, and lifestyle modifications can be recommended to improve sleep quality among medical students.
180Smartphone screen time reduction improves mental health: a randomized controlled trial.PubMed
Christoph Pieh, Elke Humer, Andreas Hoenigl, et al.
BMC Med. 2025 Feb 21;23(1):107. doi: 10.1186/s12916-025-03944-z.
BACKGROUND: Smartphone screen time has risen sharply in recent years. Even though an association between smartphone use and mental health is well documented, it is still unclear whether this is simply a correlation or causality. The aim of this study is to investigate the effects of smartphone screen time reduction on mental health indicators. METHODS: This non-blinded, parallel randomized controlled trial (RCT) was performed to investigate the impact of a 3-week screen time reduction to ≤ 2 h/d in healthy students on stress (PSQ), well-being (WHO-5), depressive symptoms (PHQ-9), and sleep quality (ISI) at baseline (t0), post-intervention (t1), and at follow-up (t2 = 6 weeks after t1). For the intention to treat analysis, repeated measures ANOVAs and post-hoc tests (for time as well as group differences) were performed and effect sizes were presented as partial eta squared (η = time × group) and group-mean differences. RESULTS: In total, 111 out of 125 healthy students (70 females; mean age = 22.68 ± 2.6 years; mean screen time = 276 ± 115.1 min/day) were randomly assigned to intervention-(n = 58; 3 weeks of screen time reduction to ≤ 2 h/day) or control group (n = 53). Although no differences were observed at baseline (t0), significant post-intervention (t1) effects of small to medium size were observed on well-being (η = .053), depressive symptoms (η = .109), sleep quality (η = .048), and stress (η = .085). Significant group differences (p ≤ .05) were found post-intervention (t1) for depressive symptoms (Mean Difference (MD) = 2.11, Standard Error (SE) = 0.63, 95% Confidence Interval (CI) [0.87, 3.36]), sleep quality (MD = 2.59, SE = 0.97, 95% CI [0.66, 4.51]), well-being (MD = -1.54, SE = 0.68, 95% CI [.-2.89, -0.18]), and stress (MD = 6.91, SE = 3.48, 95% CI [0.01, 13.81]). Screen time increased rapidly after the intervention and at follow-up the values were once again approaching the initial level. CONCLUSIONS: The study highlights mental health improvements through smartphone screen time reduction. Three weeks of screen time reduction showed small to medium effect sizes on depressive symptoms, stress, sleep quality, and well-being. The results suggest a causal relationship, rather than a merely correlative one, between daily smartphone screen time and mental health. TRIAL REGISTRATION: The study was preregistered on Open Science Framework (trial registration number: A9K76) on November 8, 2023.
181Reducing problematic social media use via a package intervention.PubMed
Lesleigh Stinson, Jesse Dallery
J Appl Behav Anal. 2023 Apr;56(2):323-335. doi: 10.1002/jaba.975. Epub 2023 Feb 13.
Problematic social media use can be characterized as that which interferes with relationships, work, school, or sleep. Currently, there are no empirically supported treatments for reducing problematic social media use. We tested a package intervention to reduce the daily duration of social media use measured by a smartphone application with nine undergraduate students who scored as "addicted" to social media via a version of the Internet Addiction Test. The package intervention included contingency management, automated notifications of application use, and the selection of alternative activities. The package intervention was effective at reducing the daily duration of social media use to goal levels, or below, for all participants. Eight out of nine participants showed a decrease in their Internet Addiction Test scores from pre- to postintervention, and overall, participants did not show an increase in the time spent engaged in their selected alternative activities. These findings demonstrate that social media use is amenable to behavioral treatment.
182Use of a supplementary internet based education program improves sleep literacy in college psychology students.PubMed
Stuart F Quan, Janis L Anderson, Gordon K Hodge
J Clin Sleep Med. 2013 Feb 1;9(2):155-60. doi: 10.5664/jcsm.2414.
INTRODUCTION: Knowledge regarding the importance of sleep in health and performance and good sleep hygiene practices is low, especially among adolescents and young adults. It is important to improve sleep literacy. Introductory psychology is one of the most highly enrolled courses at colleges and universities. This study tested the impact of an Internet-based learning module on improving sleep literacy in this venue. METHODS: An Internet-based supplementary learning module containing sleep physiology and hygiene information was developed using content from the Harvard Medical School sleep educational website http://www.understandingsleep.org. Access to the module was provided as an extra credit activity for 2 of 4 sections (Supplemental Sleep, SS, N = 889) of an introductory college psychology course during their standard instruction on sleep and dreaming. The remaining 2 sections (Standard Instruction, SI, N = 878) only were encouraged to visit the website without further direction. Level of knowledge was assessed before and after availability to the module/website and at the end of the semester. Students were asked to complete a survey at the end of the semester inquiring whether they made any changes in their sleep behaviors. RESULTS: Two hundred fifty students participated in the extra credit activity and had data available at all testing points. Students in the SS Group had a significant improvement in sleep knowledge test scores after interacting with the website in comparison to the SI group (19.41 ± 3.15 vs. 17.94 ± 3.08, p < 0.001). This difference persisted, although at a lower level, at the end of the semester. In addition, 55.9% of the SS group versus 45.1% of the SI group indicated that they made changes in their sleep habits after participation in the extra credit sleep activity (p < 0.01). The most common change was a more consistent wake time. CONCLUSION: Use of a supplementary internet-based sleep learning module has the potential to enhance sleep literacy and change behavior among students enrolled in an introductory college psychology course.
183Sleep-hygiene Education improves Sleep Indices in Elite Female Athletes.PubMed
Shannon O'Donnell, Matthew W Driller
Int J Exerc Sci. 2017 Jul 1;10(4):522-530. doi: 10.70252/DNOL2901. eCollection 2017.
The importance of sleep in providing psychophysiological recovery in elite athletes is often overlooked. In other populations (eg shift workers and adolescent students), sleep hygiene education may serve to acutely improve sleep indices. However, this is yet to be examined in an elite athlete setting. Therefore, the aim of the current study was to evaluate the effect of a sleep hygiene education session on sleep indices in elite athletes. The study involved 26 elite female netball athletes performing one week of baseline sleep monitoring (PRE), followed by a sleep hygiene education session and a further week of sleep monitoring (POST) in a single group, pre- post design. The sleep hygiene education session focused on providing information on the importance of sleep for athletes and practical tips to improve sleep quality and quantity. Sleep monitoring was performed using wrist actigraphy to assess total sleep time (TST), sleep efficiency (SE%), total time in bed (TTB), sleep latency (SL), wake episodes per night (WE), sleep onset variance (SOV), wake variance (WV) wake episode duration (WED), sleep onset time (SOT), and wake time (WT). There was a significant improvement in TST (mean ± SD; 22.3 ± 39.9 minutes, p=0.01) PRE to POST sleep hygiene education session, the difference associated with a effect (ES: 0.39). A significant improvement PRE to POST was found for WV (p=0.03), and for WED (p=0.03). There were no significant differences for SE%, SL, TTB, WE, SOV, SOT, WT. The current study reports that a sleep hygiene education session is effective in improving sleep quantity in elite female athletes in an acute setting.
184Effectiveness of sleep education programs to improve sleep hygiene and/or sleep quality in college students: a systematic review.PubMed
Shellene K Dietrich, Coleen M Francis-Jimenez, Melida Delcina Knibbs, et al.
JBI Database System Rev Implement Rep. 2016 Sep;14(9):108-134. doi: 10.11124/JBISRIR-2016-003088.
BACKGROUND: Sleep health is essential for overall health, quality of life and safety. Researchers have found a reduction in the average hours of sleep among college students. Poor sleep has been associated with deficits in attention, reduction in academic performance, impaired driving, risk-taking behaviors, depression, impaired social relationships and poorer health. College students may have limited knowledge about sleep hygiene and the behaviors that supports sleep health, which may lead to poor sleep hygiene behavior. OBJECTIVES: To identify, appraise and synthesize the best available evidence on the effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep hygiene behavior and/or sleep quality versus traditional strategies. INCLUSION CRITERIA TYPES OF PARTICIPANTS: All undergraduate or graduate college students, male or female, 18 years and older and of any culture or ethnicity. TYPES OF INTERVENTIONS: Formal sleep education programs that included a curriculum on sleep hygiene behavior. Educational delivery methods that took place throughout the participants' college experience and included a variety of delivery methods. TYPES OF STUDIES: Randomized controlled trials (RCTs) and quasi-experimental studies. OUTCOMES: Sleep hygiene knowledge, sleep hygiene behavior and/or sleep quality. SEARCH STRATEGY: Literature including published and unpublished studies in the English language from January 1, 1980 through August 17, 2015. A search of CINAHL, CENTRAL, EMBASE, Academic Search Complete, PsychINFO, Healthsource: Nursing/Academic edition, ProQuest Central, PubMed and ERIC were conducted using identified keywords and indexed terms. A gray literature search was also performed. METHODOLOGICAL QUALITY: Quantitative papers were assessed by two reviewers using critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Data were extracted using the JBI-MAStARI data extraction tool. Data extracted included interventions, populations, study methods and outcomes of significance to the review question and objectives. DATA SYNTHESIS: Meta-analysis was not possible due to limited studies and variability of design and interventions; therefore, results are presented in narrative form. RESULTS: This systematic review yielded three RCTs and one quasi-experimental study for inclusion. Two studies reported outcomes on sleep hygiene knowledge; one showing a statistically significant improvement (P = 0.025) and the other reported no difference (test of significance not provided). Two studies reported on sleep hygiene behavior; one showing no difference (P > 0.05) and the other reporting a statistically significant improvement (P = 0.0001). Four studies reported on sleep quality; three reporting no difference (P > 0.05) and the other reporting a statistically significant improvement (P = 0.017). CONCLUSION: This reviewed article identified insufficient evidence to determine the effectiveness of sleep education on sleep hygiene knowledge, sleep hygiene behavior or sleep quality in this population.