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Ebrahim YM, Sadek MA, Sabry MO, Lotfy RM, El-Dessouki AM, Abou-Hussein D, El-Shiekh RA, ElBishbishy RM. Integrative sleep management: from molecular pathways to conventional and herbal treatments. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2025:10.1007/s00210-025-04183-y. [PMID: 40338321 DOI: 10.1007/s00210-025-04183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Accepted: 04/13/2025] [Indexed: 05/09/2025]
Abstract
Sleep is regarded as one of the most crucial factors in keeping a healthy lifestyle. To function normally, a person needs at least 6-8 h of sleep per day. Sleep influences not only our mood but also the efficiency with which we complete tasks. Sleep disorders exhibit diverse etiologies across different conditions and populations, with genetic and environmental factors playing a significant role in their development. Many issues emerge as a result of inadequate sleep. Unhealthy food and lifestyle choices have increased our susceptibility to sleep disorders. A well-balanced diet rich in essential vitamins and minerals can have a profound impact on sleep patterns, enhancing both the duration and quality of rest. The primary categories of sleep disorders include insomnia, sleep apnea (SA), narcolepsy, parasomnias, circadian rhythm disorders, and restless legs syndrome (RLS). The drugs used to treat sleep disorders are primarily habit-forming and have a history of withdrawal effects. This insufficiency in medication has prompted the hunt for newer, better options. Nutraceuticals are well-suited to the treatment of such illnesses. Its non-toxic, non-habit-forming properties, and practical efficiency have made it an outstanding choice. This review provides nutraceuticals used in sleep disorders. A comprehensive literature search was conducted utilizing several databases, including Google Scholar, Elsevier, Springer Nature, Wiley, PubMed, and EKB. Nutraceuticals are products that employ food or dietary components to treat or prevent disease. In the therapy of sleep disorders, nutraceuticals such as Artemisia annua, valerian, rosemary, jujube, Passionflower, lemon balm, ashwagandha, kava-kava, lavender, and chamomile have been shown to have remarkable benefits. These remedies exert their effects through multiple mechanisms, both directly by modulating neurotransmitter and hormonal pathways within sleep circuits, and indirectly by enhancing sleep quality through the alleviation of stress, inflammation, and oxidative stress. Clinical studies were piloted to validate the efficacy of natural sleep aids. Future research should focus on elucidating the precise mechanisms through which natural products influence sleep.
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Affiliation(s)
- Yasmina M Ebrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Mohamed A Sadek
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Miral O Sabry
- Faculty of Science, National University of Singapore, Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Rana M Lotfy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Ahmed M El-Dessouki
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, 12566, Giza, Egypt
| | - Dina Abou-Hussein
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Riham A El-Shiekh
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt.
| | - Rana M ElBishbishy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
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Zhang S, Zhao Y, Qin Z, Han Y, He J, Zhao B, Wang L, Duan Y, Huo J, Wang T, Wang Y, Rong P. Transcutaneous Auricular Vagus Nerve Stimulation for Chronic Insomnia Disorder: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2451217. [PMID: 39680406 PMCID: PMC11650411 DOI: 10.1001/jamanetworkopen.2024.51217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 10/24/2024] [Indexed: 12/17/2024] Open
Abstract
IMPORTANCE Evidence from randomized clinical trials of transcutaneous auricular vagus nerve stimulation (taVNS) for chronic insomnia disorder is lacking. OBJECTIVE To evaluate the efficacy and safety of taVNS for chronic insomnia compared with the sham taVNS. DESIGN, SETTING, and PARTICIPANTS This randomized clinical trial was conducted from October 2021 to December 2022 at a single center in Beijing, China. Patients with chronic insomnia disorder with a Pittsburgh Sleep Quality Index (PSQI) of at least 8 were enrolled. Statistical analysis was performed from June to September 2023. INTERVENTIONS Patients were allocated to the active taVNS group or sham taVNS group with a 1:1 ratio. Both groups received the stimulation for 30 minutes each time, twice a day, 5 consecutive days a week, with an 8-week treatment and a 12-week follow-up. MAIN OUTCOMES AND MEASURES The primary end point was the mean change from baseline through week 8 in PSQI scores. Minimal clinically important difference was 2.5 points. Secondary outcomes included mental health, sleepiness, and fatigue. Safety was also evaluated. RESULTS A total of 72 participants were randomized to either active taVNS group (36 participants; mean [SD] age, 45.2 [14.5] years; 27 [75.0%] female) or the sham taVNS group (36 participants; mean [SD] age, 44.6 [13.9] years; 31 [86.1%] female); 68 participants completed the 8-week intervention. The least-square mean changes from baseline to week 8 in PSQI were -8.2 (95% CI, -9.3 to -7.0) points in the taVNS group and -3.9 (95% CI, -5.1 to -2.7) points in the sham group. Both groups experienced statistically significant improvements from before to after the intervention. However, active taVNS showed a clinically meaningful 4.2-point greater reduction (95% CI, -5.9 to -2.6 points; P < .001; Cohen d effect size, 1.2) in PSQI compared with the sham group (minimal clinically important difference = 2.5 points). Secondary outcomes, including mental health and fatigue, showed similar favorable results. The efficacy of taVNS was sustained throughout the 20-week study period. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, taVNS significantly reduced insomnia severity. Clinically meaningful enhancements in PSQI scores were observed compared with sham stimulation, with the benefits of taVNS sustained over a 20-week period. Future multicenter clinical trials with large sample sizes are needed to validate its effectiveness across diverse populations. Trial Registration Chinese Clinical Trial Registry: ChiCTR2100051319.
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Affiliation(s)
- Shuai Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Geriatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanan Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zongshi Qin
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Ying Han
- Acupuncture and Moxibustion Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiakai He
- Department of Traditional Chinese Medicine, Peking University People’s Hospital, Beijing, China
| | - Bin Zhao
- Department of Acupuncture, College of traditional Chinese medicine, Southern Medical University, Guangzhou, China
| | - Lei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuting Duan
- The Affiliated Traditional Chinese Medicine Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jin Huo
- Acupuncture and Moxibustion Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tuoran Wang
- Acupuncture and Moxibustion Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Wu F, Li X, Guo YN, Yan LZ, He RJ, Xu YH. Effects of insomnia treatments on cognitive function: A meta-analysis of randomized controlled trials. Psychiatry Res 2024; 342:116236. [PMID: 39427578 DOI: 10.1016/j.psychres.2024.116236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 09/15/2024] [Accepted: 10/14/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Globally, insomnia has been shown to impact cognitive function, which has prompted the exploration of effective treatments to enhance cognitive outcomes. Both pharmacological and non-pharmacological interventions vary in their effects, indicating that further research for optimized therapeutic strategies is needed. METHODS Searches of PubMed, EMBASE, Web of Science, the Cochrane Library, and PsychInfo from database inception until August 2024 were conducted to identify relevant randomized controlled studies investigating the impacts of insomnia treatments on cognitive function. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for all studies. Sensitivity analysis, publication bias, and meta-regression were performed. RESULTS A total of 14,829 records were retrieved, with 24 randomized controlled studies assessing the impact of insomnia treatment on cognition. Pooled analysis indicated that non-pharmacological interventions significantly enhanced cognitive function (SMD: 0.27, 95% CI: 0.04-0.49, p = 0.019), with notable improvements observed in memory (SMD: 1.18, 95% CI: 0.25-2.12, p = 0.013), attention (SMD: 0.32, 95% CI: 0.15-0.50, p < 0.001), and daily living activities (SMD: 0.29, 95% CI: 0.20-0.39, p < 0.001) based on self-reported measures. Longer follow-up periods were associated with more pronounced cognitive benefits (SMD: 0.34, 95% CI: 0.14-0.54, p = 0.001). CONCLUSIONS The critical role of insomnia treatments, particularly non-pharmacological interventions, in improving cognitive function is highlighted, emphasizing the importance of tailored therapeutic approaches to optimize cognitive outcomes and overall well-being.
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Affiliation(s)
- Fang Wu
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, PR China
| | - Xiao Li
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, PR China
| | - Ya-Nan Guo
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, PR China
| | - Ling-Zhao Yan
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, PR China
| | - Rong-Jie He
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, PR China
| | - Ya-Hui Xu
- Department of Sleep Medicine, Second Affiliated Hospital of Xinxiang Medical University; Henan Collaborative Innovation Center for Prevention and Treatment of Mental Disorders; Brain Institute, Henan Academy of Innovations in Medical Science, Xinxiang, PR China.
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Duthie CJ, Cameron C, Smith-Han K, Beckert L, Delpachitra S, Garland SN, Sparks B, Wibowo E. Reasons for why Medical Students Prefer Specific Sleep Management Strategies. Behav Sleep Med 2024; 22:516-529. [PMID: 38369858 DOI: 10.1080/15402002.2024.2318261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Insomnia symptoms are common among medical students. This study explored the perspectives of medical students about which sleep management strategies to use. METHODS Medical students responded to an online survey on their thoughts about the use of various sleep management strategies. RESULTS Of the 828 respondents, 568 (69%) provided responses to questions about the most preferred strategies and 450 (54%) provided responses about their least preferred strategies. About 48.5% felt their insomnia symptoms were too mild to see a clinician and 23.9% did not think their symptoms warranted sleep medication. Over 40% of students could not avoid work before sleep, have consistent sleep/wake times, or engage in regular exercise because of their busy and inconsistent schedules. Approximately 40-60% could not improve their sleep environment (e.g. better heating and bed) because of the associated costs. Over 80% reported an inability to change their pre-sleep habits (e.g. using electronics close to bedtime, using bed for activities other than sleep or sex). Half of the students disliked relaxation techniques or felt they would not help. Around 30-50% did not believe that changing caffeine and/or alcohol intake would affect their sleep. CONCLUSIONS Medical students may benefit from additional sleep education. Clinicians may need to discuss which strategies individual students prefer and modify their recommendations accordingly.
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Affiliation(s)
- Cassian J Duthie
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Claire Cameron
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Kelby Smith-Han
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Health Professions Education, University of Western Australia, Perth, Australia
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, Newfoundland, Canada
| | - Bryn Sparks
- Sleep Well Clinic, Christchurch, New Zealand
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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Zhang CQ, Zhang XD, Wang Y, Liu YH, Zhang CL, Zhang Q. Sleep promoting and omics exploration on probiotics fermented Gastrodia elata Blume. NPJ Sci Food 2024; 8:33. [PMID: 38890318 PMCID: PMC11189394 DOI: 10.1038/s41538-024-00277-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
Fermenting Chinese medicinal herbs could enhance their bioactivities. We hypothesized probiotic-fermented gastrodia elata Blume (GE) with better potential to alleviate insomnia than that of unfermented, thus the changes in chemical composition and the insomnia-alleviating effects and mechanisms of fermented GE on pentylenetetrazole (PTZ)-induced insomnia zebrafish were explored via high-performance liquid chromatography (HPLC) and mass spectroscopy-coupled HPLC (HPLC-MS), phenotypic, transcriptomic, and metabolomics analysis. The results demonstrated that probiotic fermented GE performed better than unfermented GE in increasing the content of chemical composition, reducing the displacement, average speed, and number of apoptotic cells in zebrafish with insomnia. Metabolomic investigation showed that the anti-insomnia effect was related to regulating the pathways of actin cytoskeleton and neuroactive ligand-receptor interactions. Transcriptomic and reverse transcription qPCR (RT-qPCR) analysis revealed that secondary fermentation liquid (SFL) significantly modulated the expression levels of neurod1, msh2, msh3, recql4, ercc5, rad5lc, and rev3l, which are mainly involved in neuron differentiation and DNA repair. Collectively, as a functional food, fermented GE possessed potential for insomnia alleviation.
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Affiliation(s)
- Chao-Qi Zhang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling, 712100, China
| | - Xu-Dong Zhang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling, 712100, China
| | - Yan Wang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling, 712100, China
| | - Yi-Han Liu
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling, 712100, China
| | - Cun-Li Zhang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling, 712100, China.
- Key Laboratory of Edible Plant Enzyme R&D and Monitoring, Shaanxi Wuding Biotechnology Co., Ltd., Hanzhong, 724400, China.
| | - Qiang Zhang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling, 712100, China.
- Key Laboratory of Edible Plant Enzyme R&D and Monitoring, Shaanxi Wuding Biotechnology Co., Ltd., Hanzhong, 724400, China.
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Kudo M, Ayabe N, Takeshima M, Ogasawara M, Itoh Y, Yoshizawa K, Kitamura S, Mishima K. Association between sleep state misperception and bedtime behavior in patients with chronic insomnia. Sci Rep 2024; 14:13991. [PMID: 38886489 PMCID: PMC11183147 DOI: 10.1038/s41598-024-64355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
Previous studies on sleep state misperception have objectively evaluated sleep status in special environments using polysomnography. There is a paucity of data from studies that evaluated habitual sleep status in home environments. The present study aimed to investigate sleep state misperception in the home environment of patients with chronic insomnia using a lumbar-worn actigraphy to identify sleep habits associated with sleep state misperception severity. Thirty-one patients and 42 healthy volunteers were included in the insomnia and non-insomnia group, respectively. Participants recorded subjective assessments in sleep diaries, objective assessments with an actigraphy worn for 14 days, and self-assessments using questionnaires. Both groups had similar objective sleep ratings; however, insomnia group had significantly worse subjective ratings (total sleep time, wake after sleep onset, and sleep onset latency). A significant correlation was found between subjective and objective total sleep time scores in non-insomnia group but not in insomnia group. Insomnia group had earlier bedtimes, significantly longer bedtimes, and impaired daytime functioning (Sheehan Disability Scale score); additionally, they underestimated their total sleep time, particularly with earlier bedtimes and longer laying durations. Monitoring the sleep status and habits of individuals in home environments could be instrumental in identifying key points for targeted interventions on sleep hygiene and cognitive behavioral therapy for insomnia.
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Affiliation(s)
- Mizuki Kudo
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Naoko Ayabe
- Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, 1-1 Tegata-Gakuenmachi, Akita, 010-8502, Japan
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Yu Itoh
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Kazuhisa Yoshizawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan.
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan.
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Bahji A, Crockford D, Brasch J, Schutz C, Buckley L, Danilewitz M, Dubreucq S, Mak M, George TP. Training in Substance use Disorders, Part 1: Overview of Clinical Practice Recommendations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:428-456. [PMID: 38613369 PMCID: PMC11107443 DOI: 10.1177/07067437241231128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Anees Bahji
- Clinical Assistant Professor, Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Crockford
- Clinical Professor, University of Calgary, Cumming School of Medicine, Department of Psychiatry, Calgary, AB, Canada; Hotchkiss Brain Institute & Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada
| | - Jennifer Brasch
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Lead, Addiction Psychiatry, St. Joseph's Healthcare, Hamilton, ON, Canada; Past-President, Canadian Society of Addiction Medicine, Calgary, AB, Canada
| | - Christian Schutz
- Professor, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Research Lead Adult Mental Health and Substance Use, Provincial Health Service Authority, Vancouver, BC, Canada
| | - Leslie Buckley
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marlon Danilewitz
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Associate Medical Director, General Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Simon Dubreucq
- Psychiatrist, Department of Addiction Medicine, CHUM, Montreal, QC, Canada; Assistant Professor, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Michael Mak
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Adjunct Assistant Professor, Department of Medicine, McMaster University, Hamilton, ON, Canada; Adjunct Research Professor, Department of Psychiatry, Western University, London, ON, Canada
| | - Tony P George
- Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Doos Ali Vand H, Hooman F, Sardarzehi R, Bastami M, Jansson-Fröjmark M. Prediction of insomnia severity based on early maladaptive schemas: a logistic regression analysis. Sleep Breath 2024; 28:919-927. [PMID: 37393219 DOI: 10.1007/s11325-023-02873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND In spite of the major role of early maladaptive schemas in vulnerability to various psychological disorders, studies about the relationship between early maladaptive schemas and insomnia disorder are scarce. Hence, the aim of the current study was to explore the contribution of early maladaptive schemas in insomnia severity by comparing a sample of patients with chronic insomnia and good sleepers. METHODS Patients with chronic insomnia and good sleepers were evaluated using Young Schema Questionnaire-Short Form (YSQ-SF), Depression Anxiety and Stress Scale (DASS-21), and Insomnia Severity Index (ISI). RESULTS The study enrolled 117 patients with chronic insomnia and 76 good sleepers. All early maladaptive schemas (EMSs) except for enmeshment showed significant correlations with insomnia severity. After controlling for depression/anxiety symptoms, logistic regression analysis showed that the EMSs including emotional deprivation, vulnerability to harm, and subjugation schemas were significantly associated with insomnia severity. CONCLUSIONS These preliminary findings suggest that EMSs may constitute a vulnerability factor for developing insomnia. Early maladaptive schemas may require attention in the existing treatments of insomnia.
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Affiliation(s)
- Hoda Doos Ali Vand
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Taleghani Educational Hospital, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, Iran
| | - Farzaneh Hooman
- Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Reyhaneh Sardarzehi
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran.
| | - Malek Bastami
- Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute & Stockholm Health Care Services, Region Stockholm, Sweden
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Zambelli Z, Halstead EJ, Fidalgo AR, Mangar S, Dimitriou D. Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single arm feasibility study. Front Psychol 2024; 14:1266368. [PMID: 38274683 PMCID: PMC10808483 DOI: 10.3389/fpsyg.2023.1266368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Objectives A large proportion of individuals with chronic pain experience insomnia-related symptoms which can be persistent in nature, and negatively impact one's quality of life. This single arm trial aimed to investigate the feasibility and preliminary efficacy of CBT-I, adapted for people with chronic musculoskeletal pain, delivered via telehealth. Methods We conducted a single arm feasibility trial in which 10 adult women (M age = 50.76 years, SD = 8.03 years) with self-reported insomnia and a diagnosed chronic musculoskeletal chronic pain received six CBT-I individual treatment sessions over 6-10 weeks. Treatment was delivered via telehealth. Participants completed weekly sleep diaries, and self-reported measures of insomnia, pain, anxiety and depression pre-treatment, post-treatment, and one-month follow-up. Results The trial yielded, high levels of compliance with intervention protocols, and affirmative feedback on satisfaction which demonstrated feasibility. The enrolment rate into the study was 37% (27 participants screened, 10 participants enrolled). The intervention was associated with statistically and clinically meaningful improvements in self-reported insomnia severity. There were statistically significant improvements in sleep efficiency, wake after sleep onset, sleep onset latency, anxiety and depression. Conclusion Adapted CBT-I delivered via telehealth may be a feasible, acceptable, and efficacious therapeutic approach for individuals with co-existent sleep and chronic pain. Future trials should adopt a randomized design against usual care.
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Affiliation(s)
- Zoe Zambelli
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | | | - Stephen Mangar
- Department of Clinical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
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McCabe SE, Schulenberg JE, Wilens TE, Schepis TS, McCabe VV, Veliz P. Transitions in Prescription Benzodiazepine Use and Misuse and in Substance Use Disorder Symptoms Through Age 50. Psychiatr Serv 2023; 74:1154-1162. [PMID: 37143335 PMCID: PMC10867819 DOI: 10.1176/appi.ps.20220247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Prescription benzodiazepines are among the most commonly used and misused controlled medications. The authors aimed to examine transitions from medical use of prescription benzodiazepines to prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms during adulthood. METHODS Eleven national cohorts of U.S. 12th graders (N=26,575) were followed up from ages 18 (1976-1986) to 50 (2008-2018). Prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms were examined with prevalence estimates and multivariable logistic regression. RESULTS By age 35, 70.9% of respondents had not used or misused prescription benzodiazepines, 11.3% reported medical use only, 9.8% indicated both medical use and misuse, and 14.1% reported misuse only. In analyses adjusted for demographic and other characteristics, adults reporting only medical use of prescription benzodiazepines by age 35 had higher odds of later prescription benzodiazepine misuse (adjusted OR [AOR]=2.17, 95% CI=1.72-2.75) and prescription opioid misuse (AOR=1.40, 95% CI=1.05-1.86) than respondents ages 35-50 who never used prescription benzodiazepines. More frequent medical use of prescription benzodiazepines by age 35 was associated with increased risk for substance use disorder symptoms at ages 40-50. Any history of prescription benzodiazepine misuse by age 35 was associated with higher odds of later prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms, compared with no misuse. CONCLUSIONS Prescription benzodiazepine use or misuse may signal later prescription drug misuse or substance use disorders. Medical use of prescription benzodiazepines by age 35 requires monitoring for prescription drug misuse, and any prescription benzodiazepine misuse warrants an assessment for substance use disorder.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - John E Schulenberg
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Timothy E Wilens
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Ty S Schepis
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Vita V McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
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Zang S, Chen Y, Chen H, Shi H, Zhou L. Effects of acupuncture on the brain in primary insomnia: a coordinate-based meta-analysis of fMRI studies. Front Neurol 2023; 14:1180393. [PMID: 37533466 PMCID: PMC10392941 DOI: 10.3389/fneur.2023.1180393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/30/2023] [Indexed: 08/04/2023] Open
Abstract
Importance Primary insomnia (PI) has a high global incidence, and effective treatments with fewer side effects are needed. Acupuncture, a treatment used in traditional Chinese medicine, has become increasingly established as a treatment method for PI and is recognized by many physicians and patients. Some evidence has suggested that acupuncture was associated with improvements in objective sleep parameters and might induce changes in some brain regions. Individual studies with limited sample size and low detection thresholds may lead to false positives, and no systematic review of the effects of acupuncture has been conducted in PI. Objective The aim of this systematic review and coordinate-based meta-analysis was to summarize the literature on fMRI evaluation of patients with PI treated with acupuncture. Design We performed a methodical and comprehensive search of multiple publication databases (from inception to December 2022): Web of Science, PubMed, ScienceDirect, Embase, Wan Fang, China National Knowledge Infrastructure, and Chinese Scientific Journal Database. Bias and quality of studies were evaluated by three researchers. Furthermore, a seed-based D-mapping meta-analysis with permutation of subject images (SDM-PSI) was applied to investigate the central mechanisms behind acupuncture treatment at PI. The International Prospective Registry of Systematic Reviews received the protocol for this study. (PROSPERO: CRD42023400086). Results The analysis included 305 patients with PI and 116 healthy controls from 11 studies. SDM-PSI analysis showed that patients with PI exhibited increased amplitudes of regional homogeneity and low-frequency fluctuations in the left superior frontal gyrus (1352 voxels, p = 0.0028), right angular gyrus (14 voxels, p = 0.0457), and cerebellum (12 voxels, p = 0.0446). Acupuncture improved the function of right superior frontal gyrus (1, 404 voxels, p = 0.0123), left inferior frontal gyrus (1068 voxels, p = 0.0088), left inferior temporal gyrus (903 voxels, p = 0.0074), left supramarginal gyrus (888 voxels, p = 0.0113), left precuneus (457 voxels, p = 0.0247), right precuneus (302 voxels, p = 0.0191), left supplementary motor area (82 voxels, p = 0.0354), and right parahippocampal gyrus (28 voxels, p = 0.0379). The brain regions affected by non-acupoint acupuncture were all located in the frontal lobe. The Cochrane risk-of bias tool and MINORS5 were used for quality assessment and the included articles had high performance bias and attrition bias. Conclusion This coordinate-based meta-analysis found that acupuncture in patients with PI had significant effects on the default mode network, particularly on the frontal lobe and precuneus, and that non-acupoint acupuncture may provide some benefit to frontal brain region function. Systematic review registration PROSPERO: CRD42023400086.
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Affiliation(s)
- Shuhan Zang
- The First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Chen
- The First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Haonan Chen
- The First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Huawei Shi
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Li Zhou
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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12
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Çiftçi B, Yıldız GN, Yıldız Ö. Hospital-acquired insomnia scale: A validity and reliability study. World J Psychiatry 2023; 13:113-125. [PMID: 37033894 PMCID: PMC10075024 DOI: 10.5498/wjp.v13.i3.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/04/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Sleep breathing, one of the basic human needs, is a physiological need that affects cardiac functions, body temperature, daily vitality, muscle tone, hormone secretion, blood pressure, and many more. In the international literature, studies reported that patients have had sleep problems in the hospital since the 1990s, but no measurement tool has been developed to determine the causes of hospital-acquired insomnia in individuals. These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing. Although patients generally experience hospital-acquired sleep problems, there is no measurement tool to determine hospital-acquired sleep problems. These features show the originality of the research. AIM To develop a measurement tool to determine the sleep problems experienced by patients in the hospital. METHODS A personal information form, hospital-acquired insomnia scale (HAIS), and insomnia severity index (ISI) were used to collect research data. The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022. The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage. Exploratory factor analysis and confirmatory factor analysis (CFA) analyses were performed using the SPSS 20 package program and the analysis of moment structure (AMOS) package program. Equivalent forms method used. RESULTS The HAIS consisted of 18 items and 5 subscales. The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783. The scale explained 58.269% of the total variance. The items that constitute the factors were examined in terms of content integrity and named as physical environmental, psychological, safety, socioeconomic, and nutritional factors. CFA analysis of the 5-factor structure was performed in the AMOS package program. The fit indices of the obtained structure were examined. It was determined that the values obtained from the fit indices were sufficient. A significant correlation was determined between the HAIS and the ISI, which was used for the equivalent form method. CONCLUSION The HAIS is a valid and reliable measurement tool for determining patients' level of hospital-acquired insomnia. It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.
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Affiliation(s)
- Bahar Çiftçi
- Department of Fundamental of Nursing, Atateknokent Atatürk University, Erzurum 25000, Turkey
| | - Güzel Nur Yıldız
- Department of Dialysis, Muş Alparaslan University, Muş 49000, Turkey
| | - Özgür Yıldız
- Department of Nursing, Muş Alparslan University, Muş 49000, Turkey
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13
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Melatonin for Insomnia in Medical Inpatients: A Narrative Review. J Clin Med 2022; 12:jcm12010256. [PMID: 36615056 PMCID: PMC9821578 DOI: 10.3390/jcm12010256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
In this narrative review, we describe what is known about non-pharmacological and pharmacological treatments for insomnia in medical inpatients, with a focus on melatonin. Hospital-acquired insomnia is common, resulting in shortened total sleep time and more nighttime awakenings. Sleep disturbance has been shown to increase systemic inflammation, pain, and the likelihood of developing delirium in hospital. Treatment for insomnia includes both non-pharmacological and pharmacological interventions, the latter of which requires careful consideration of risks and benefits given the known adverse effects. Though benzodiazepines and non-benzodiazepine benzodiazepine receptor agonists are commonly prescribed (i.e., sedative-hypnotics), they are relatively contraindicated for patients over the age of 65 due to the risk of increased falls, cognitive decline, and potential for withdrawal symptoms after long-term use. Exogenous melatonin has a comparatively low likelihood of adverse effects and drug-drug interactions and is at least as effective as other sedative-hypnotics. Though more research is needed on both its effectiveness and relative safety for inpatients, small doses of melatonin before bedtime may be an appropriate choice for inpatients when insomnia persists despite non-pharmacological interventions.
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14
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Gao Y, Liu M, Yao L, Yang Z, Chen Y, Niu M, Sun Y, Chen J, Hou L, Sun F, Wu S, Zhang Z, Zhang J, Li L, Li J, Zhao Y, Fan J, Ge L, Tian J. Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis. J Evid Based Med 2022; 15:216-229. [PMID: 35996803 DOI: 10.1111/jebm.12485] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT-I) on insomnia in cancer patients. METHODS We searched five databases up to February 2021 for randomized clinical trials that compared CBT-I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta-analyses and frequentist network meta-analyses with the random-effects model were applied for data analyses. RESULTS Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT-I could significantly reduce insomnia severity (mean differences [MD] = -4.98 points, 95% confidence interval [CI]: -5.82 to -4.14), SOL (MD = -12.29 min, 95%CI: -16.48 to -8.09), and WASO (MD = -16.58 min, 95%CI: -22.00 to -11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT-I could significantly reduce insomnia severity (MD = -2.75 points, 95%CI: -4.28 to -1.21), SOL (MD = -13.56 min, 95%CI: -18.93 to -8.18), and WASO (MD = -6.99 min, 95%CI: -11.65 to -2.32) at postintervention. These effects diminished in short-term follow-up and almost disappeared in long-term follow-up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta-analysis showed that group CBT-I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short-term follow-up. CONCLUSIONS CBT-I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short-term follow-up. Group CBT-I is the preferred choice based on postintervention and short-term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high-quality, large-scale trials providing long-term follow-up data.
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Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ming Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Zhirong Yang
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Liangying Hou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shanshan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zeqian Zhang
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lun Li
- Department of Breast Cancer, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhao
- First Clinical Medical College, Lanzhou University, Lanzhou, China
- Departments of Biochemistry and Molecular Biology, Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jingchun Fan
- Epidemiology and Evidence Based-Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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15
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Acupuncture for insomnia in people with cancer. Cochrane Database Syst Rev 2022; 2022:CD015177. [PMCID: PMC9407041 DOI: 10.1002/14651858.cd015177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of acupuncture therapy for insomnia in people with cancer, during and after active anti‐cancer treatment. We will evaluate the effects at different periods of treatment in relation to cancer treatment (before, during, or after treatment), and analyse the effects of acupuncture on quality of life.
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Cognitive behavioural therapy for insomnia in people with cancer. Cochrane Database Syst Rev 2022; 2022:CD015176. [PMCID: PMC9387101 DOI: 10.1002/14651858.cd015176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of cognitive behavioural therapy (CBT) for insomnia in people with cancer. We will evaluate the effects at different periods of the cancer treatment (before, during, or after treatment), and analyse the effects of CBT on quality of life.
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Evrard P, Pétein C, Beuscart JB, Spinewine A. Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework. Implement Sci 2022; 17:41. [PMID: 35804428 PMCID: PMC9264665 DOI: 10.1186/s13012-022-01206-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Many strategies aimed at deprescribing benzodiazepine receptor agonists (BZRA) in older adults have already been evaluated with various success rates. There is so far no consensus on which strategy components increase deprescribing the most. Yet, despite an unfavourable benefit-to-risk ratio, BZRA use among older adults remains high. We systematically reviewed barriers and enablers for BZRA deprescribing in older adults. Methods Two reviewers independently screened records identified from five electronic databases—Medline, Embase, PsycINFO, CINAHL and the Cochrane library—and published before October 2020. They searched for grey literature using Google Scholar. Qualitative and quantitative records reporting data on the attitudes of older adults, caregivers and healthcare providers towards BZRA deprescribing were included. Populations at the end of life or with specific psychiatric illness, except for dementia, were excluded. The two reviewers independently assessed the quality of the included studies using the mixed-methods appraisal tool. Barriers and enablers were identified and then coded into domains of the theoretical domains framework (TDF) using a combination of deductive and inductive qualitative analysis. The most relevant TDF domains for BZRA deprescribing were then identified. Results Twenty-three studies were included 13 quantitative, 8 qualitative and 2 mixed-method studies. The points of view of older adults, general practitioners and nurses were reported in 19, 9 and 3 records, respectively. We identified barriers and enablers in the majority of TDF domains and in two additional themes: “patient characteristics” and “BZRA prescribing patterns”. Overall, the most relevant TDF domains were “beliefs about capabilities”, “beliefs about consequences”, “environmental context and resources”, “intention”, “goals”, “social influences”, “memory, attention and decision processes”. Perceived barriers and enablers within domains differed across settings and across stakeholders. Conclusion The relevant TDF domains we identified can now be linked to behavioural change techniques to help in the design of future strategies and health policies. Future studies should also assess barriers and enablers perceived by under-evaluated stakeholders (such as pharmacists, psychiatrists and health care professionals in the hospital setting). Trial registration This work was registered on PROSPERO under the title “Barriers and enablers to benzodiazepine receptor agonists deprescribing”. Registration number: CRD42020213035 Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01206-7.
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Affiliation(s)
- Perrine Evrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Yvoir, Belgium
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Insomnio, en busca del tratamiento ideal: fármacos y medidas no farmacológicas. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Affiliation(s)
- Lauren Z Waterman
- South London and Maudsley NHS Foundation Trust Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK
| | - Hugh Selsick
- Insomnia and Behavioural Sleep Medicine, UCLH, London, UK
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Abbasi K. You can’t stop the bleep. Assoc Med J 2021. [DOI: 10.1136/bmj.n863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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