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Treatment of Insomnia and Sleep Disorders

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 35512

Special Issue Editor


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Guest Editor
1. Institute of Cognitive Science, Woosuk University, 443 Samnye-ro, Samnye-eup, Wanju-gun, Jeollabuk-do, Republic of Korea
2. Department of Psychiatry, University Witten-Herdecke, 58455 Witten, Germany
Interests: sleep medicine; sleep breathing disorders; insomnia; shiftwork; CBT-I; sleep health promotion; circadian rhythm; CBT-PTS; CBT-D; CBT-A; neuro-cognitive functions

Special Issue Information

Dear Colleagues,

Sleep medicine is a fast-growing area of medical practice that involves multiple medical and health professions. This Special Issue is dedicated to emerging digital and virtual methods for diagnosis and treatment of sleep disorders. Many of these new approaches are suitable for use in telemedicine. This Special Issue calls for papers: (1) reporting on the effectiveness, and implementation of wearables in the diagnosis of sleep disorders, (2) contrasting the utility of diverse physiological and kinematic signals for detecting sleep disorders, (3) reporting on the usage of telemedicine methods in the treatment of sleep apnea, insomnia and other sleep disorders, and (4) evaluating diagnostic and therapeutic effectiveness and efficacy of apps and online therapies for sleep disorders.

Prof. Dr. Antje Büttner-Teleagă
Guest Editor

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Keywords

  • digital sleep medicine
  • virtual sleep medicine
  • telemedicine
  • online sleep therapy
  • wearables in sleep medicine

Published Papers (10 papers)

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Research

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12 pages, 362 KiB  
Article
Associations between Sleep Quality, Frailty, and Quality of Life among Older Adults in Community and Nursing Home Settings
by Mateja Lorber, Sergej Kmetec, Adam Davey, Nataša Mlinar Reljić, Zvonka Fekonja and Barbara Kegl
Int. J. Environ. Res. Public Health 2023, 20(6), 4937; https://doi.org/10.3390/ijerph20064937 - 10 Mar 2023
Cited by 1 | Viewed by 1650
Abstract
Poor sleep quality is prevalent among older adults, but limited data document associations between frailty and quality of life comparing individuals living in the community with those in nursing homes. This cross-sectional study (conducted between August and November 2019) included 831 older adults [...] Read more.
Poor sleep quality is prevalent among older adults, but limited data document associations between frailty and quality of life comparing individuals living in the community with those in nursing homes. This cross-sectional study (conducted between August and November 2019) included 831 older adults (mean age 76.5 years) from Slovenia’s community and nursing home settings. The results showed comorbidity in 38% of community-dwelling older adults and 31% of older adults in nursing homes. The prevalence of frailty among community-dwelling older adults was 36.5%, and among older adults in a nursing home was 58.5%. A total of 76% of community-dwelling older adults and 95.8% of nursing home residents reported poor sleep quality. Sleep quality and frailty predict 42.3% of the total variability of quality of life for older adults in nursing homes and 34.8% for community-dwelling older adults. The study’s results indicate that the quality of life can be affected by factors (e.g., worse sleep quality and frailty) among older adults, regardless of being a resident or from the community. Understanding how sleep quality is affected by social, environmental, and biological factors can help improve sleep quality and potentially the quality of life of older adults. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
12 pages, 5278 KiB  
Article
Sleep Patterns during the COVID-19 Lockdown in Spain
by Noelia Ruiz-Herrera, Amparo Díaz-Román, Alejandro Guillén-Riquelme and Raúl Quevedo-Blasco
Int. J. Environ. Res. Public Health 2023, 20(6), 4841; https://doi.org/10.3390/ijerph20064841 - 09 Mar 2023
Cited by 6 | Viewed by 1098
Abstract
Background: To mitigate the spread of the coronavirus disease (COVID-19) pandemic, governments around the world adopted exceptional lockdown measures. This led to the disruption of normal life routines, including sleep. The aim of this study was to analyze differences in sleep patterns and [...] Read more.
Background: To mitigate the spread of the coronavirus disease (COVID-19) pandemic, governments around the world adopted exceptional lockdown measures. This led to the disruption of normal life routines, including sleep. The aim of this study was to analyze differences in sleep patterns and subjective variables of sleep quality before and during lockdown. Methods: A sample of 1673 Spanish adults (30% men; 82% of the total were between 21 and 50 years of age) was evaluated. The following sleep variables were evaluated: Sleep latency, sleep time, number and duration of awakenings, sleep satisfaction, daytime sleepiness, and the manifestation of symptoms related to sleep problems. Results: Although 45% of people changed their sleep schedules (resulting in 42% sleeping longer during lockdown), sleep quality (37.6% worse), daytime sleepiness (28% worse), number of awakenings (36.9% more), and duration of awakenings (45% longer) were markedly worse. Statistical analyses indicated significant differences in all the evaluated sleep variables before and during lockdown in both men and women. Women reported less sleep satisfaction, and more symptoms related to sleep problems than men. Conclusions: A deterioration in the sleep patterns of the Spanish population, especially women, because of the lockdown declared due to the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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10 pages, 1056 KiB  
Article
Measuring Sleep Quality in the Hospital Environment with Wearable and Non-Wearable Devices in Adults with Stroke Undergoing Inpatient Rehabilitation
by Michael Pellegrini, Natasha A. Lannin, Richelle Mychasiuk, Marnie Graco, Sharon Flora Kramer and Melita J. Giummarra
Int. J. Environ. Res. Public Health 2023, 20(5), 3984; https://doi.org/10.3390/ijerph20053984 - 23 Feb 2023
Viewed by 1300
Abstract
Sleep disturbances are common after stroke and may affect recovery and rehabilitation outcomes. Sleep monitoring in the hospital environment is not routine practice yet may offer insight into how the hospital environment influences post-stroke sleep quality while also enabling us to investigate the [...] Read more.
Sleep disturbances are common after stroke and may affect recovery and rehabilitation outcomes. Sleep monitoring in the hospital environment is not routine practice yet may offer insight into how the hospital environment influences post-stroke sleep quality while also enabling us to investigate the relationships between sleep quality and neuroplasticity, physical activity, fatigue levels, and recovery of functional independence while undergoing rehabilitation. Commonly used sleep monitoring devices can be expensive, which limits their use in clinical settings. Therefore, there is a need for low-cost methods to monitor sleep quality in hospital settings. This study compared a commonly used actigraphy sleep monitoring device with a low-cost commercial device. Eighteen adults with stroke wore the Philips Actiwatch to monitor sleep latency, sleep time, number of awakenings, time spent awake, and sleep efficiency. A sub-sample (n = 6) slept with the Withings Sleep Analyzer in situ, recording the same sleep parameters. Intraclass correlation coefficients and Bland–Altman plots indicated poor agreement between the devices. Usability issues and inconsistencies were reported between the objectively measured sleep parameters recorded by the Withings device compared with the Philips Actiwatch. While these findings suggest that low-cost devices are not suitable for use in a hospital environment, further investigations in larger cohorts of adults with stroke are needed to examine the utility and accuracy of off-the-shelf low-cost devices to monitor sleep quality in the hospital environment. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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13 pages, 736 KiB  
Article
The Mediator Role of Routines on the Relationship between General Procrastination, Academic Procrastination and Perceived Importance of Sleep and Bedtime Procrastination
by Paula Magalhães, Beatriz Pereira, André Oliveira, David Santos, José Carlos Núñez and Pedro Rosário
Int. J. Environ. Res. Public Health 2021, 18(15), 7796; https://doi.org/10.3390/ijerph18157796 - 22 Jul 2021
Cited by 11 | Viewed by 9751
Abstract
Background: Sleep plays a key role in our overall function, and sleep insufficiency has been highlighted as a major health issue. ‘Bedtime procrastination’—i.e., needlessly delaying the time one goes to bed without external reasons—is one reason for sleep insufficiency. The present research aims [...] Read more.
Background: Sleep plays a key role in our overall function, and sleep insufficiency has been highlighted as a major health issue. ‘Bedtime procrastination’—i.e., needlessly delaying the time one goes to bed without external reasons—is one reason for sleep insufficiency. The present research aims to explore the interrelationships among Bedtime Procrastination, other domains of Procrastination, and routine-related variables. Methods: The mediating effects of Wake-up Time and Dinner Time on the relationship between Bedtime Procrastination and General Procrastination, Academic Procrastination, and Perceived Importance of Sleep were tested. Self-reported questionnaires were used, and the sample comprised of 446 university students. Results: A partial mediation model was found. General Procrastination, Academic Procrastination, and Perceived Importance of Sleep showed direct effects on Bedtime Procrastination. Moreover, Academic and General Procrastination were positively associated with Bedtime Procrastination, whereas Perceived Importance of Sleep was negatively associated with Bedtime Procrastination. Indirect effects of the Perceived Importance of Sleep and General Procrastination, as mediated by Wake-up Time and Dinner Time, on Bedtime Procrastination were also found. Conclusions: Personal routines (Wake-up Time and Dinner Time) along with individual characteristics (General and Academic Procrastination) and beliefs (perceived importance of sleep) may affect Bedtime Procrastination. Present results highlight the complexity of Bedtime Procrastination. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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10 pages, 999 KiB  
Article
Accuracy of a Smartphone Application Measuring Snoring in Adults—How Smart Is It Actually?
by Katharina Klaus, Anna-Lena Stummer and Sabine Ruf
Int. J. Environ. Res. Public Health 2021, 18(14), 7326; https://doi.org/10.3390/ijerph18147326 - 08 Jul 2021
Cited by 7 | Viewed by 2787
Abstract
About 40% of the adult population is affected by snoring, which is closely related to obstructive sleep apnea (OSA) and can be associated with serious health implications. Commercial smartphone applications (apps) offer the possibility of monitoring snoring at home. However, the number of [...] Read more.
About 40% of the adult population is affected by snoring, which is closely related to obstructive sleep apnea (OSA) and can be associated with serious health implications. Commercial smartphone applications (apps) offer the possibility of monitoring snoring at home. However, the number of validation studies addressing snoring apps is limited. The purpose of the present study was to assess the accuracy of recorded snoring using the free version of the app SnoreLab (Reviva Softworks Ltd., London, UK) in comparison to a full-night polygraphic measurement (Miniscreen plus, Löwenstein Medical GmbH & Co., KG, Bad Ems, Germany). Nineteen healthy adult volunteers (4 female, 15 male, mean age: 38.9 ± 19.4 years) underwent simultaneous polygraphic and SnoreLab app measurement for one night at home. Parameters obtained by the SnoreLab app were: starting/ending time of monitoring, time in bed, duration and percent of quiet sleep, light, loud and epic snoring, total snoring time and Snore Score, a specific score obtained by the SnoreLab app. Data obtained from polygraphy were: starting/ending time of monitoring, time in bed, total snoring time, snore index (SI), snore index obstructive (SI obstructive) and apnea-hypopnea-index (AHI). For different thresholds of percentage snoring per night, accuracy, sensitivity, specificity, positive and negative predictive values were calculated. Comparison of methods was undertaken by Spearman-Rho correlations and Bland-Altman plots. The SnoreLab app provides acceptable accuracy values measuring snoring >50% per night: 94.7% accuracy, 100% sensitivity, 94.1% specificity, 66.6% positive prediction value and 100% negative prediction value. Best agreement between both methods was achieved in comparing the sum of loud and epic snoring ratios obtained by the SnoreLab app with the total snoring ratio measured by polygraphy. Obstructive events could not be detected by the SnoreLab app. Compared to polygraphy, the SnoreLab app provides acceptable accuracy values regarding the measurement of especially heavy snoring. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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10 pages, 1625 KiB  
Article
Insomnia Associated with Tinnitus and Gender Differences
by Kneginja Richter, Melanie Zimni, Iva Tomova, Lukas Retzer, Joachim Höfig, Stefanie Kellner, Carla Fries, Karina Bernstein, Wolfgang Hitzl, Thomas Hillemacher, Lence Miloseva and Jens Acker
Int. J. Environ. Res. Public Health 2021, 18(6), 3209; https://doi.org/10.3390/ijerph18063209 - 19 Mar 2021
Cited by 18 | Viewed by 3240
Abstract
Chronic tinnitus causes a decrease in well-being and can negatively affect sleep quality. It has further been indicated that there are clinically relevant gender differences, which may also have an impact on sleep quality. By conducting a retrospective and explorative data analysis for [...] Read more.
Chronic tinnitus causes a decrease in well-being and can negatively affect sleep quality. It has further been indicated that there are clinically relevant gender differences, which may also have an impact on sleep quality. By conducting a retrospective and explorative data analysis for differences in patients with tinnitus and patients diagnosed with tinnitus and insomnia, hypothesized differences were explored in the summed test scores and on item-level of the validated psychometric instruments. A cross-sectional study was conducted collecting data from a sample of tinnitus patients (n = 76). Insomnia was diagnosed in 49 patients. Gender differences were found on aggregated test scores of the MADRS and BDI with men scoring higher than women, indicating higher depressive symptoms in men. Women stated to suffer more from headaches (p < 0.003), neck pain (p < 0.006) and nervousness as well as restlessness (p < 0.02). Women also reported an increase in tinnitus loudness in response to stress compared to men (p < 0.03). Male individuals with tinnitus and insomnia have higher depression scores and more clinically relevant depressive symptoms than women, who suffer more from psychosomatic symptoms. The results indicate a need for a targeted therapy of depressive symptoms in male patients and targeted treatment of psychosomatic symptoms, stress-related worsening of insomnia and tinnitus in women. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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9 pages, 1027 KiB  
Article
Analyses of Weight/Blood Pressure Changes before and after Tonsillectomy in Adults: A Longitudinal Follow-Up Study
by Jee Hye Wee, Chanyang Min, Dae Myoung Yoo, Min Woo Park, Chang Myeon Song, Bumjung Park and Hyo Geun Choi
Int. J. Environ. Res. Public Health 2021, 18(4), 1948; https://doi.org/10.3390/ijerph18041948 - 17 Feb 2021
Cited by 1 | Viewed by 2283
Abstract
This study aimed to evaluate the changes in weight and blood pressure in Korean adults who underwent tonsillectomy compared to controls. A nested case-control study used data from the Korean National Health Insurance Service-Health Screening Cohort (2002–2015). Tonsillectomy was defined using claim code [...] Read more.
This study aimed to evaluate the changes in weight and blood pressure in Korean adults who underwent tonsillectomy compared to controls. A nested case-control study used data from the Korean National Health Insurance Service-Health Screening Cohort (2002–2015). Tonsillectomy was defined using claim code Q2300. The changes in weight and systolic/diastolic blood pressure (SBP/DBP) were measured before tonsillectomy and 1 year after tonsillectomy (study I) in some participants and during the second year after tonsillectomy (study II) in other participants. Patients who underwent tonsillectomy (n = 569 in study I; n = 556 in study II) were 1:4 matched with control participants (n = 2276 in study I; n = 2224 in study II). The paired t-test and linear mixed model were used to test the differences between groups at each time point. There were no changes in body mass index (p = 0.732 in study I; p = 0.128 in study II), SBP (p = 0.344 in study I; p = 0.559 in study II), or DBP (p = 0.826 in study I; p = 0.524 in study II) between the tonsillectomy patients and controls in the first or second year postoperatively. Subgroup analyses by age, sex, and degree of obesity showed consistent results. Tonsillectomy does not lead to a change in weight or blood pressure in Korean adults. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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Review

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12 pages, 373 KiB  
Review
Insomnia among Cancer Patients in the Real World: Optimising Treatments and Tailored Therapies
by Irene Pinucci, Annalisa Maraone, Lorenzo Tarsitani and Massimo Pasquini
Int. J. Environ. Res. Public Health 2023, 20(5), 3785; https://doi.org/10.3390/ijerph20053785 - 21 Feb 2023
Cited by 2 | Viewed by 2289
Abstract
Background: Insomnia is commonly reported by cancer patients. Its multifaceted pathophysiology makes this symptom a complex challenge for the clinician, who should bear in mind the manifold world of causes and consequences of sleep disturbances in these patients and the importance of accurate [...] Read more.
Background: Insomnia is commonly reported by cancer patients. Its multifaceted pathophysiology makes this symptom a complex challenge for the clinician, who should bear in mind the manifold world of causes and consequences of sleep disturbances in these patients and the importance of accurate treatment that should consider the frequent co-prescription of multiple medications. With our work, we aim to provide a tool to better master the treatment of this symptom in cancer patients, considering the gap between clinical and pharmacodynamic knowledge about the efficacy of different molecules and evidence-based prescribing. Methods: A narrative review of the studies investigating the pharmacological treatment of insomnia in cancer patients was conducted. Three hundred and seventy-six randomised controlled trials (RCTs), systematic reviews and meta-analyses were identified through PubMed. Only publications that investigated the efficacy of the pharmacological treatment of insomnia symptoms in cancer patient were considered. Results: Among the 376 publications that were individuated, fifteen studies were eligible for inclusion in the review and were described. Pharmacological treatments were outlined, with a broad look at specific clinical situations. Conclusions: The management of insomnia in cancer patients should be personalised, as is already the case for the treatment of pain, taking into account both the pathophysiology and the other medical treatments prescribed to these patients. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)

Other

Jump to: Research, Review

14 pages, 371 KiB  
Protocol
Pharmacopuncture Effects on Insomnia Disorder: Protocol for a Multi-Site, Randomized, Acupuncture-Controlled, Clinical Trial
by Jung-Hwa Lim, Jae-Hyok Lee, Chan-Young Kwon, Sang-Hyup Lee, Chang-Wan Kang, Eun Cho, Hyun-Woo Kim, Jun-Hee Cho and Bo-Kyung Kim
Int. J. Environ. Res. Public Health 2022, 19(24), 16688; https://doi.org/10.3390/ijerph192416688 - 12 Dec 2022
Cited by 2 | Viewed by 1700
Abstract
Insomnia is a common health problem that can lead to various diseases and negatively impact quality of life. Pharmacopuncture is a new type of acupuncture that involves applying herbal medicine extracts to acupoints. Korean medicine doctors frequently use it to treat insomnia disorder. [...] Read more.
Insomnia is a common health problem that can lead to various diseases and negatively impact quality of life. Pharmacopuncture is a new type of acupuncture that involves applying herbal medicine extracts to acupoints. Korean medicine doctors frequently use it to treat insomnia disorder. However, there is insufficient evidence to support the effectiveness and safety of pharmacopuncture for insomnia disorder. We designed a pragmatic randomized controlled trial to compare the effectiveness of pharmacopuncture and acupuncture for insomnia disorder. This multi-site, randomized, acupuncture-controlled trial will enroll 138 insomnia patients. The subjects will be randomly assigned to one of two groups, pharmacopuncture or acupuncture, at a 2:1 ratio. For 4 weeks, the participants will receive ten sessions of pharmacopuncture or acupuncture treatment and will be followed up for 4 weeks after the treatment ends. The Pittsburgh Sleep Quality Index score is the primary outcome measure. Insomnia severity index score, sleep parameters recorded using actigraphy and sleep diaries, physical symptoms associated with insomnia, emotions, quality of life, medical costs, and safety are the secondary outcome measures. The findings of this trial willprovide evidence that will be useful in clinical decision-making for insomnia treatment strategies. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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38 pages, 599 KiB  
Systematic Review
Sleep Disorders in Cancer—A Systematic Review
by Antje Büttner-Teleagă, Youn-Tae Kim, Tiziana Osel and Kneginja Richter
Int. J. Environ. Res. Public Health 2021, 18(21), 11696; https://doi.org/10.3390/ijerph182111696 - 07 Nov 2021
Cited by 42 | Viewed by 7615
Abstract
Introduction: Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, [...] Read more.
Introduction: Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment. Methods: A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis. Results: The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%. Discussion: Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states. Full article
(This article belongs to the Special Issue Treatment of Insomnia and Sleep Disorders)
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