Daytime sleepiness, driving performance, reaction time and inhibitory control during sleep restriction therapy for Chronic Insomnia Disorder

Crown Copyright © 2017 Published by Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (Nov 2017) in accordance with the publisher’s archiving policyBackground Sleep restriction therapy (SRT) is a largely untested single treatment component of cognitive-behaviour therapy for insomnia. To date, the evidence for contraindications for SRT is limited to very few studies. The present study investigated the objective and subjective daytime consequences during the acute phase of SRT for adults diagnosed with Chronic Insomnia Disorder. Methods Sixteen adults (age = 36.3 ± 13.4 yrs, 12 females, 4 males) underwent SRT for their insomnia over a two week period based on recommendations by Miller and colleagues (2014) [6]. Participants completed sleep diaries, self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]), as well as objective measures of reaction time/inhibition (Go/NoGo task) and driving performance (AusEd driving simulator) at pre-, mid- (ie, after one week of SRT) and post-SRT (after two weeks of SRT). Results Sleep diary outcomes indicated participants complied with the restriction of time in bed, and that a similar amount of total sleep time (TST) was maintained from pre-to-post-treatment. There was no significant change in daytime sleepiness, and similarly no significant changes observed in objective performance on the Go/NoGo task and AusEd driving simulator. Conclusions These preliminary results suggest SRT during the acute phase does not appear to place insomnia patients at risk of significant impairments in sleepiness and reaction times. We note these findings can only be translated into clinical practice when sleep duration remains relatively unchanged. Future studies using objective measures of sleep and a control group are recommended

Estimating adolescent sleep patterns: parent reports versus adolescent self-report surveys, sleep diaries, and actigraphy

In research and clinical contexts, parent reports are often used to gain information about the sleep patterns of their adolescents; however, the degree of concordance between parent reports and adolescent-derived measures is unclear. The present study compares parent estimates of adolescent sleep patterns with adolescent self-reports from surveys and sleep diaries, together with actigraphy. Methods: A total of 308 adolescents (59% male) aged 13–17 years completed a school sleep habits survey during class time at school, followed by a 7-day sleep diary and wrist actigraphy. Parents completed the Sleep, Medical, Education and Family History Survey. Results: Parents reported an idealized version of their adolescent’s sleep, estimating significantly earlier bedtimes on both school nights and weekends, significantly later wake times on weekends, and significantly more sleep than either the adolescent self-reported survey, sleep diary, or actigraphic estimates. Conclusion: Parent reports indicate that the adolescent averages a near-optimal amount of sleep on school nights and a more than optimal amount of sleep on weekends. However, adolescent-derived averages indicate patterns of greater sleep restriction. These results illustrate the importance of using adolescent-derived estimates of sleep patterns in this age group and the importance of sleep education for both adolescents and their parents

An open trial of bedtime fading for sleep disturbances in preschool children: a parent group education approach

© 2017 Elsevier BV. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (March 2018) in accordance with the publisher’s archiving policyStudy Objectives: To evaluate the efficacy of bedtime fading to reduce sleep disturbances in preschool aged children, using a group parent education format. Design: A repeated-measures design (pre-treatment, treatment, post-treatment and 2-year follow-up). Setting: Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia Participants: Participants were 21 children (mean age=3.0±0.80 years, range=1.5-4.0 yrs; 60% girls) identified as having difficulty initiating sleep, night waking, or a combination of both, and their mothers (M age=36.1±4.2 years). Interventions: Mothers attended two group sessions which included basic sleep education (sleep needs, sleep architecture, sleep homeostasis) and bedtime fading instruction. Measurements and Results: Primary outcome variables were sleep onset latency (SOL), wake after sleep onset (WASO), and bedtime tantrums, measured using 2-week maternal report sleep diaries. Immediate improvements were observed over pre-treatment to treatment in average SOL per night (M=23.2±11.3min vs M=13.0±7.3min, d=0.91), average WASO per night (M=32.4±23.1min vs. M=24.0±18.3min, d=0.41), and number of bedtime tantrums per week (M=1.7±3.0 vs. M=0.4±0.7, d=0.43). Treatment gains were maintained at 2-year follow-up. Mothers rated bedtime fading highly in terms of usefulness and satisfaction, and could successfully re-implement treatment when needed. Conclusions: Bedtime fading is a brief and promising intervention for pre-schoolers’ sleep difficulties. This simple intervention can be easily implemented by parents in the home with little instruction, resulting in improvements to sleep and bedtime tantrums

A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with Delayed Sleep-Wake Phase Disorder

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (February 2018) in accordance with the publisher’s archiving policyA randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13–24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups; and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30–0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45–0.87) post-treatment. Improvements in sleep timing (d = 0.53–0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52–1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed

Does comorbid obstructive sleep apnea impair the effectiveness of cognitive and behavioral therapy for insomnia?

This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (Sept 2017) in accordance with the publisher’s archiving policyAims Comorbid insomnia and obstructive sleep apnea (OSA) represents a highly prevalent and debilitating condition; however, physicians and researchers are still uncertain about the most effective treatment approach. Several research groups have suggested that these patients should initially receive treatment for their insomnia before the sleep apnea is targeted. The current study aims to determine whether Cognitive and Behavioral Therapy for Insomnia (CBT-i) can effectively treat insomnia in patients with comorbid OSA and whether its effectiveness is impaired by the presence of OSA. Methods A retrospective chart review was conducted to examine 455 insomnia patients entering a CBT-i treatment program in a hospital out-patient setting. Three hundred and fourteen patients were diagnosed with insomnia alone and 141 with insomnia and comorbid OSA. Improvements in average sleep diary parameters, global insomnia severity, and several daytime functioning questionnaires from baseline, to post-treatment, to 3-month follow-up were compared between insomnia patients with and without comorbid OSA. Results Insomnia patients with comorbid OSA experienced significant improvements in insomnia symptoms, global insomnia severity, and other daytime functioning measures during and following treatment. Furthermore, improvements were no different between patients with or without comorbid OSA. Sleep apnea presence and severity were not related to rates of insomnia-remission or treatment-resistance following treatment. Conclusions CBT-i is an effective treatment in the presence of comorbid OSA. This information offers support for the suggestion that patients with comorbid insomnia and OSA should be treated with CBT-i prior to the treatment of the OSA

Mechanisms Influencing Older Adolescents’ Bedtimes during Videogaming: The Roles of Game Difficulty and Flow

This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (August 2017) in accordance with the publisher’s archiving policyA relationship between evening technology use and sleep has been established, and models suggest various mechanisms to explain this relationship. Recent updates to these models also suggest the influence of individual difference factors, such that the relationship between technology and sleep varies between young people. Flow is an experience of immersion and time distortion that could vary between adolescents when using technology. The aim of the present study was to investigate the effects of flow on the self-selected bedtimes of adolescents when videogaming. Seventeen older adolescent, experienced videogamers (age = 15.9 ± 0.83 years), played a new videogame on two school-night evenings in a sleep laboratory. Game difficulty was set to “hard” one evening (flow condition) and “easy” on the other evening (disrupted flow). Trait and state flow were measured, along with heart rate during videogaming, and bedtime measured objectively with real-time cameras. An interaction effect for heart rate indicated an elevated heart rate in the easy condition after 150 min of gaming (p < 0.02). No significant differences were found in bedtimes between the easy and hard conditions (p = 0.77). Adolescents high on trait flow played for longer and selected significantly later bedtimes than their low trait flow peers but only for the hard (flow) condition (12:22 AM vs. 10:53 PM, p = 0.004). Similarly, adolescents with high state flow went to bed significantly later than those low on state flow (12:24 PM vs. 10:52 PM, p = 0.001), again only in the hard condition. These findings suggest that individual and situational characteristics may amplify the effects of technology use on the “sleep” of adolescents and provides support for the displacement of bedtime hypothesis

The role of pre-sleep cognitions in adolescent sleep-onset problems

© 2018 Elsevier BV. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (March 2018) in accordance with the publisher’s archiving policy.Study Objectives: To examine the relationship between pre-sleep cognitions and sleep-onset difficulties in an adolescent sample. Methods: Participants were 385 students (59% male) from grades 9 to 11, between 13 and 18 yrs old (M=15.6, SD=1.0), from 8 co-educational high schools of varied socioeconomic status in metropolitan Adelaide, South Australia. The cross-sectional study used a questionnaire battery including the Sleep Anticipatory Anxiety Questionnaire - Adolescent Version [SAAQ-A], completed during school time, followed by 8 days of sleep diary completion and wearing wrist actigraphy to obtain subjective and objective sleep onset latency [SOL]. Results: Significant relationships were found between somatic arousal (SAAQ-A subscale) and objective SOL, and between sleep-related cognitions (SAAQ-A subscale) and subjective SOL and SOL overestimation (sleep misperception). No relationships were found between subjective SOL and somatic or rehearsal and planning cognitions. Objective SOL was not related to rehearsal and planning, or sleep-related cognition scores, and sleep misperception had no relationship with somatic, and rehearsal and planning cognition scores. Conclusions: These findings are similar to those in clinical adult populations, but also notably different, for example the lack of association between negative sleep-related pre-sleep cognitions and objective sleep difficulty. This study’s results provide a basis for existing relationships between negative pre-sleep cognitions and subjective and objective sleep difficulties in this population to be examined causally in more detail

Readiness to change and commitment as predictors of therapy compliance in adolescents with Delayed Sleep-Wake Phase Disorder

© 2018 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ 12 month embargo from date of publication (Dec 2018) per publisher’s policyObjectives Recent evidence indicates that adolescents' motivation to change sleep-wake patterns is low, despite significant impact of adolescent sleep problems on many areas of daytime functioning. The aim of the present study is to evaluate components of adolescents' motivation, and subsequent changes in behaviour. Methods Fifty-six adolescents, aged 13–23 (M = 15.8 ± 2.3 y; 38% m) diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD) underwent three therapy sessions involving bright light therapy to phase advance sleep patterns. Adolescents were instructed to advance wake-up times by 30-min daily. Motivation ratings of desire, ability, reason, need and commitment to change sleep patterns were taken at baseline. Sleep diaries were taken at the end of treatment session 1, with sequentially earlier wake-up times in 30-min intervals indicating compliance. Results At the outset of therapy, adolescents indicated strong desire, reasons and need, yet moderate ability and commitment to advance their sleep-wake patterns. Following therapy, sleep-onset times were significantly advanced, total sleep time increased and sleep latency decreased (all p 0.05). Adolescents' desire to change (r = 0.30, p = 0.03) and commitment (r = 0.30, p = 0.03) were positively correlated with behaviour change, but their need, ability and reasons were not. A mediation analysis showed that ability and desire were important in predicting behaviour change, by total effects through commitment (ie, indirectly and directly). Conclusion Our findings suggest that the total effects of ability (ie, confidence) and desire to change are the best predictors of behavioural changes, thus clinicians should focus on these components of the readiness to change model when undertaking treatments with sleep-disordered adolescents

Relationships between the circadian rhythms of finger temperature, core temperature, sleep latency, and subjective sleepiness

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