chronic insomnia

Americans are getting more ZZZZs

Decline in reading and watching TV before bed and increasing opportunities to perform tasks online and from home could be why

January 18, 2018

University of Pennsylvania School of Medicine

Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated in the American Time Use Survey (ATUS) between 2003 and 2016, most Americans averaged an extra 7.5 hours of sleep each year over the 14-year period. The study, by researchers at the Perelman School of Medicine at the University of Pennsylvania, was published online this month in the journal Sleep.

 

The findings reveal that daily sleep duration increased by 1.4 minutes on weekdays and 0.8 minutes on weekends per year. At first glance, this may not seem like substantial progress. However, over the 14-year period it translates to 17.3 minutes more sleep each night, or 4.4 full days more sleep each year. This is the first study to show that sleep duration has increased among broad segments of the United States population (students 15 and older, people who are employed, and retirees) over this period. The increase in sleep duration was mostly explained by respondents turning in earlier at night, and to a lesser degree by getting up later in the morning.

 

In addition to sleep, the ATUS covers all waking activities over a 24-hour period and thus allowed Penn researchers to investigate behaviors that could be responsible for the increase in sleep duration. For example, over the 14-year period, fewer respondents decided to read or watch TV prior to bed in the evening, two prominent activities that compete with sleep for time.

 

"This shows an increased willingness in parts of the population to give up pre-bed leisure activities to obtain more sleep," said the study's lead author, Mathias Basner, MD, PhD, an associate professor of Sleep and Chronobiology in Psychiatry. "Also, the data suggest that increasing opportunities to work, learn, bank, shop, and perform administrative tasks online and from home freed up extra time, and some of it was likely used to get more sleep."

 

No significant sleep time trend was found for unemployed respondents or those not in the labor force, thus bringing attention to the difficulty of work/family balance and the finding that sometimes people sacrifice sleep to make the other two work. In earlier work, the Penn team identified time spent working as the #1 waking activity competing with sleep for time. Changes in time spent working were not found to play a substantial role in the increasing sleep time trend in this study, though.

 

The study also showed that the number of Google searches on the topic "sleep" has more than doubled and scientific publications on "short sleep" and its consequences has grown more than 10 fold from 2003 to 2016, and was highly correlated with the observed increase in sleep duration. Although the team says this does not prove causality, it gives hope that increasing awareness through reports of insufficient sleep and its consequences as well as campaigns to encourage healthy sleep -- such as the 2013 National Healthy Sleep Awareness Project -- may be working.

 

The dangers of short sleep are well documented. Earlier research by senior author David F. Dinges, PhD, chief of the division of Sleep and Chronobiology, showed that cognitive performance and vigilant attention decline quickly after being awake past 16 hours or if sleep is chronically curtailed, which increases the risk for errors and accidents. Also, additional studies have found associations between chronic short sleep and obesity, hypertension, diabetes, cardiovascular disease, and declines in cognitive function.

 

In 2015, the American Academy of Sleep Medicine and Sleep Research Society published a consensus statement that adults should sleep 7 or more hours per night on a regular basis to promote optimal health.

 

"As researchers, increasing awareness of short sleep and its consequences remains a critically important task to improve public health," said Basner. "At the same time, this data provides new hope that these efforts may be effective in motivating many Americans to sleep more."

 

The researchers caution that the findings need to be replicated and that there is still a long way to go in the fight against chronic, widespread sleep loss. Since the ATUS is a survey, more population research with objective measures of sleep is needed. The authors also add that an increase in reported "long sleep," i.e. for more than nine hours each night, of 0.48 percent/year over this 14-year period, calls for further research into the health effects of "long sleep."

https://www.sciencedaily.com/releases/2018/01/180118175315.htm

Cognitive Behavioral Therapy is an Effective Treatment for Chronic Insomnia

June 16, 2009

Science Daily/American Academy of Sleep Medicine

A majority of people experiencing chronic insomnia can experience a normalization of sleep parameters through the use of cognitive behavioral therapy for insomnia, according to new research.

 

Results indicate that 50 percent to 60 percent of participants with chronic sleep onset insomnia, sleep maintenance insomnia or both experienced remission of their primary sleep difficulty. Among the 64 participants who completed five or more treatment sessions, there were significant improvements on presenting complaints, as well as all other measures, including sleep efficiency, average nightly awakenings, total sleep time and average nights of sleep medication use per week.

 

The multi-component, CBT-I program included comprehensive evaluations of patients' habits, attitudes and knowledge concerning sleep. The program was designed to involve six to seven treatment sessions. Specific strategies included education on sleep regulating systems, sleep scheduling recommendations, sleep hygiene education, sleep consolidation therapy, stimulus control therapy, relaxation training, cognitive therapy and mindfulness training.

 

According to Wetzler, a related study found that of participants who completed at least four treatment sessions of CBT-I, 78 percent of those using sleep medication for three or more nights per week were able to completely discontinue use of sleep medications. Findings from this study indicate that those who discontinued use of sleep medications not only stopped using drugs to sleep but also slept better than when they were taking sleep medications.

http://www.sciencedaily.com/releases/2009/06/090609072709.htm

 

Chronic Insomnia Requires Increased Brain Activation to Maintain Daily Function

June 12, 2009

Science Daily/American Academy of Sleep Medicine

Patients suffering from chronic primary insomnia have higher levels of brain activation compared to normal sleepers during a working memory test.

 

According to a research abstract that will be presented on June 9, at Sleep 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, patients suffering from chronic primary insomnia (PIs) have higher levels of brain activation compared to normal sleepers during a working memory test.

 

Results show that PIs use increased brain activation relative to good sleepers during the working memory task, particularly in areas responsible for visual-spatial attention and coordination of cognitive processes. This activation may explain how PIs maintain performance on the task despite their sleep difficulties. PIs also were found to have decreased activation in visual and motor areas, which may suggest that PIs have higher baseline activation in these regions relative to good sleepers.

http://www.sciencedaily.com/releases/2009/06/090609072811.htm

Adolescents with Chronic Insomnia Report 2x – 5x Increase in Personal Problems

March 23, 2008

Science Daily/University of Texas Health Science Center at Houston

Chronic insomnia is costing adolescents more than sleep. It’s been linked to a wide range of physical, psychological and interpersonal problems, according to public health researchers at The University of Texas Health Science Center at Houston, who completed the first prospective study of adolescents with persistent sleep problems.

 

Documenting a “twofold to fivefold” increase in personal problems among adolescents with persistent sleeplessness, public health researchers at The University of Texas Health Science Center at Houston say they have completed the first prospective study demonstrating the negative impact of chronic insomnia on 11 to 17 year olds.

 

More than one fourth of the youths surveyed had one or more symptoms of insomnia and almost half of these youngsters had chronic conditions. Findings appear in the March issue of the Journal of Adolescent Health and are based on interviews with 3,134 adolescents in metropolitan Houston.

http://www.sciencedaily.com/releases/2008/03/080320192339.htm

Service members diagnosed with chronic insomnia may face increased risk of type II diabetes, high blood pressure

November 4, 2014

Science Daily/Armed Forces Health Surveillance Center (AFHSC)

Service members diagnosed with chronic insomnia had a two times higher risk of developing hypertension and type II diabetes than military personnel who had not been diagnosed with the condition, according to a newly released health surveillance report of a study of the associations between these diseases.

 

Insomnia is a common complaint among service members due to career-related stress factors, such as frequent deployments with demanding military operations, varying work shifts, and the challenges of maintaining relationships with their spouses and families.

 

"This type of analysis has military relevance because it supports the notion that adequate sleep among our service members is important not only for accident prevention and work performance, but also for additional long-term health benefits," said Air Force Lieutenant Colonel Paul E. Lewis, the author of the study and a preventive medicine resident at the Uniformed Services University of the Health Sciences.

 

The association of chronic insomnia with hypertension was seen both in service members younger than 30 years of age and in those aged 30 years or older, with adjusted hazard ratios of 2.32 and 1.94, respectively. By gender, chronic insomnia had a stronger association with hypertension in men (adjusted hazard ratio of 2.17) than in women (adjusted hazard ratio of 1.59).

 

The adjusted hazard ratio was also greater for white, non-Hispanics (ratio of 2.26) than for black, non-Hispanics (ratio of 1.72). Both obese subjects and non-obese subjects had significantly increased risks of hypertension related to insomnia, with adjusted hazard ratios of 2.09 and 1.86, respectively.

 

Previous studies on this topic have provided conflicting results, with some demonstrating a strong association and others finding minimal to no association. There are several reasons why the findings of this study may not be directly comparable to studies in civilian populations. Military members are generally younger and have less co-morbidity than their civilian counterparts.

 

This analysis employed a longitudinal study design that allowed for follow-up of individuals over time, whereas many previous study designs did not allow evaluation between an exposure to a risk factor and a subsequent outcome. The average follow-up time was 3.09 years in the insomnia cohort and 3.42 years in the control cohort. These differences in methodology might partially explain the observed increased risks of hypertension and diabetes associated with chronic insomnia in this study but not seen in some other studies.

http://www.sciencedaily.com/releases/2014/11/141104111156.htm

Taking stock of research on sleepless soldiers

October 16, 2013

Science Daily/Springer

Various behavioral treatment options are helping to treat the sleeplessness experienced by American soldiers who have been deployed in recent military operations. A review of research has been done on deployment-related insomnia among military personnel and veterans, conducted since 2010.

 

Insomnia is reported by up to 54 percent of the two million men and women who have served in various American combat efforts since 11 September 2001, compared to up to 22 percent of civilian adults. Although it is possible that a person's insomnia may develop prior to joining the military, it can also occur during the service period, or post-deployment when the soldier returns to civilian life. Studies have found that deployment-related stressors like combat exposure, mild traumatic brain injury, irregular sleep/wake schedules and the adjustment of returning home, all contribute to sleeplessness.

 

Soldiers who suffer from insomnia while being deployed have a bigger chance of developing traumatic stress reactions such as depression and posttraumatic stress disorders, and even committing suicide. Also, it contributes to physical war-related injuries.

 

Behavioral interventions such as cognitive-behavioral therapy and imagery rehearsal therapy often yield positive results in trying to reduce the effects of insomnia and nightmares, respectively. These treatments can be delivered during in-person sessions with clinicians, brief follow up sessions via telephone, or online and mobile resources. Training was recently rolled out to prepare providers in the Veterans Health Administration to use cognitive behavioral treatment of insomnia.

 

The goal is to eventually educate 1,000 clinicians in an effort to bridge the gap between veterans who need treatment, and available providers. Training of clinicians in military settings and other non-VA clinics is equally important to meet the needs of our service members and veterans.

 

"Training providers to be knowledgeable about insomnia and behavioral treatment options is a vital component to the treatment of chronic insomnia and managing its impact on other disorders," say the authors, who believe more research is needed on methods to increase access to care.

 

"In addition to research and clinical efforts specifically for service members and veterans, research and clinical efforts directed at military family members are also important components in providing the care needed and promoting health and recovery among service members and their families."

http://www.sciencedaily.com/releases/2013/10/131016123732.htm

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